Becoming a top-level athlete requires training and competition at high intensity and heavy loads on the spine, often from a very early age. Training with the aim of reaching an elite performance level often requires monotonous and repetitive strenuous physical exercise, which increases the risk of traumatic and, more frequently, overuse injuries with greater risk of disturbed musculoskeletal growth and/or tissue morbidity. The injury patterns are different in growing athletes compared with adults, as young athletes more commonly experience avulsion injuries of the ring apophasis of vertebral endplates in the growth zone whereas the adults suffer vertebral body fractures or vertebral disc rupture. Different spinal loading patterns such as variable combinations of axial compression, flexion, extension, or rotation contribute to the incidence of athletic spinal injury. Individual differences in sagittal plane spinal curvature can contribute to some individuals being more susceptible to spinal injury from specific high intensity or high repetition loads. To prevent spinal injuries in athletes, the most important factor is to avoid high intensity or repetition spinal loads until the athlete is older than 18 years of age. The amount of training is of fundamental importance to reduce and avoid overuse injuries on the spine in athletes. Before and during their growth spurt, young, developing athletes should focus more on athletic movement coordination, quality techniques, and balance. Whenever possible, they should avoid extreme spinal bending movements. Training programs and competitive events should place greater consideration on the age and maturation level of developing athletes.