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11 This overload injury usually involves the biceps femoris and surrounding tissue. For example, overloading injuries typically occur in a lengthened position, as in high-speed running, when the hamstring is eccentrically contracting across the hip and knee, and late in swing phase/ early heel strike. 4 Different mechanisms of injury may be associated with unique injury locations and specific structural impairments. 3, 18 A variety of injury mechanisms for HSIs have been described and typically involve some type of eccentric overloading and/or overstretching in a position of hip flexion and knee extension. 3, 18 Classifications also may consider whether there is myofascial, musculotendinous, and/or intratendinous involvement. 55 Typically, HSIs are classified by the involved muscle, anatomical location, and severity of damage. 18 The high reinjury rate is also an important issue.

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In professional sports, HSIs may be associated with significant financial costs. Hamstring strain injury (HSI) may result in considerable impairment, activity limitation, and participation restriction, including time lost from competitive sports. The hamstring muscle group consists of 3 muscles in the posterior thigh: the semitendinosus, semimembranosus, and biceps femoris. However, we suggest that significant departures from accepted guidelines should be documented in the patient's medical records at the time the relevant clinical decision is made. The ultimate judgment regarding a particular clinical procedure or treatment plan must be made based on clinician experience and expertise, considering the clinical presentation of the patient, the available evidence, available diagnostic and treatment options, and the patient's values, expectations, and preferences. Adherence to them will not ensure a successful outcome in every patient, nor should they be construed as including all proper methods of care or excluding other acceptable methods of care aimed at the same results. These parameters of practice should be considered guidelines only. Standards of care are based on all clinical data available for an individual patient and are subject to change, as scientific knowledge and technology advance and patterns of care evolve. These guidelines are not intended to be construed or to serve as a standard of medical care. Create a reference publication for orthopaedic physical therapy clinicians, academic instructors, clinical instructors, students, interns, residents, and fellows regarding the best current practice of orthopaedic physical therapy.Provide information for payers and claims reviewers regarding the practice of orthopaedic physical therapy for common musculoskeletal conditions.Provide a description to policy makers, using internationally accepted terminology, of the practice of orthopaedic physical therapists.Identify appropriate outcome measures to assess changes resulting from physical therapist interventions in body function and structure, as well as in activity and participation of these individuals.

Identify interventions supported by current best evidence to address impairments of body function and structure, activity limitations, and participation restrictions associated with common musculoskeletal conditions.

Classify and define common musculoskeletal conditions using the World Health Organization's terminology related to impairments of body function and structure, activity limitations, and participation restrictions.

Describe evidence-based physical therapist practice, including diagnosis, prognosis, intervention, and assessment of outcome, for musculoskeletal disorders commonly managed by orthopaedic physical therapists.

108 The purposes of these CPGs are as follows: The Academy of Orthopaedic Physical Therapy (AOPT) and the American Academy of Sports Physical Therapy (AASPT) of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based clinical practice guidelines (CPGs) for orthopaedic and sports physical therapist management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability and Health (ICF).

Mike Voight, PT, DHSc, OCS, SCS, ATC, FAPTA ,.

Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health From the Academy of Orthopaedic Physical Therapy and the American Academy of Sports Physical Therapy of the American Physical Therapy Association

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