During the past two decades, there has been a significant increase in organized sports participation by female athletes. Spinal injury and deformity have become growing concerns. The female athlete has a unique interaction of mechanical, hormonal, and nutritional factors that place her at risk for spinal problems. Certain sports expose the growing spine to motions beyond the normal physiologic range. Furthermore, high-visibility sports exert an additional image demand on the athlete and may result in lower estrogen production. The combination of rigorous participation, hormonal imbalance, and growing bone may predispose the athlete to spinal pathologies. Early identification of these problems, along with risk factor modification, will minimize the injuries.