The method for rating impairments for lumbar spine injuries has evolved over time and has changed with each edition of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). The AMA Guides, Sixth Edition, uses a diagnosis-based impairment rating system as the template for evaluating impairment ratings for spinal conditions. A majority of US states use the AMA Guides to determine an impairment rating for injured workers and use this impairment rating to determine financial compensation, but no state system is the same as another's, and each state has a unique statutory scheme. Some cases warrant the finding of a permanent impairment when the injured worker has significant residual pain complaints and limitations that have been verified by the evaluator as being consistently present from the injury date. The AMA Guides, Sixth Edition, allows an assignment of permanent impairment, at the discretion of the evaluator, in cases of chronic lumbar sprains/strains. Evaluators should carefully consider whether it is appropriate to assign an award of permanent impairment for spinal conditions without verifiable objective findings. An evaluator's decision of no impairment vs class 1 impairment is a significant determination in compensation claims and will continue to include subjective factors until advances in medical science permit a more accurate assessment of complaints of non-specific back pain.