In this paper, we describe "state of the art" on the diagnosis and treatment for low back pain in athletes. Lumbar motion that induces specific pain would be a clue to the exact diagnosis. In the flexion pain group, lumbar herniated nucleus pulposus is the most common disorder. Discogenic pain and type 1 Modic endplate inflammation may also cause flexion pain; however, the diagnosis is sometimes difficult. In children and adolescents, apophyseal ring fracture is prevalent. In the extension pain group, lumbar spondylolysis is very common, especially in pediatric athletes. In adults, facet pain due to overloading would be the pathology, while low back pain with trunk rotation is not common. However, throwing athletes, such as pitchers and hammer throwers, may experience this kind of pain; facet arthritis contralateral to the throwing arm would be the origin of the pain. Low back pain on lumbar lateral bending is rare, but we experienced some cases in golfers in whom type 1 Modic change at the lateral corner was the source of pain. In this article, we explained strategies for state-of-the-art diagnosis and minimally invasive treatment.