A sacral pedicle stress fracture is an uncommon source of low back pain in adolescent athletes. Given the extensive differential diagnosis of low back pain coupled with the fact that nondirected specific imaging can be normal, diagnosis can be delayed. We report the case of a 15-year-old African American male, dual-sport athlete who experienced low back pain from a sacral pedicle stress fracture. This case highlights the importance of a thorough history and physical examination in tandem with appropriate testing to identify predisposing factors to ultimately arrive at a diagnosis. A comprehensive, conservative treatment approach is described.