Part 2 – The Ultimate Gift: Tissue Donation

Reconstructing Ligaments Using Donated Tissue – from ESPN The Magazine

The story of a young man gone too soon and a grateful recipient’s football dreams

Michael Collins’ life was tragically cut short, but he continues to make a difference in the lives of others after donating his organs. His mother, Kelly Collins, still remembers the day Fleming ligamentMichael announced he had signed up as a donor. “A letter arrived from the secretary of state,” she says. “That day Michael was breezing in and out of the house doing something and I said, ‘Hey, you signed up to become a donor?’ And he yelled back, ‘Yep!’ I said, ‘Do you know what that means?’ ‘Yep!’ And out the door he went. He didn’t ask permission or our opinion. Signing up was the right thing to do, so he did it. That was Michael.”


On March 29, the car carrying Michael and two classmates was struck at an intersection by a drunken driver who had run a red light traveling more than 100 mph. After four days in the ICU and two brain surgeries, when Michael’s fate had become imminent, his family agreed to honor the pledge he made on his 18th birthday to become an organ and tissue donor-allowing surgeons time to recover enough of his organs and tissue to save or improve the lives of as many as 200 recipients.

“Michael was the ultimate athlete from the time he was born,” Kelly continues. “To think that it has now come full circle, that his cartilage and bone and tissue could live on and benefit other athletes in this higher way, well, I looked down at the list of possible donations they gave me and just kept saying ‘Yes, yes, yes, yes.’”

TRAVIS SCHERTZ’S LASTING CONNECTION: Travis didn’t even make it out of the parking lot before his mangled right knee began to throb, again. By June 2013, Schertz, a speedy 6-foot-2, 205-pound sophomore wide-out at Minnesota State, had endured seven tedious, tortuous months of rehab following his fourth — and, he was assured, final — knee surgery. When he first arrived on campus, Schertz had dreams of fine tuning his power-forward explosiveness and following former Minnesota State receiver Adam Thielen to the NFL. Chronic cartilage problems, however, had left bone grinding against bone in his knee. Every time he used his leg, it shot white-hot, throbbing jolts of pain through his body, as if he had bitten his tongue.

Fleming ligament

Travis spent the next month researching alternative, advanced and cutting-edge orthopedic solutions. A pattern emerged. Every hit seemed to include the name of the same doctor: Chicago’s Brian Cole, the team physician for the Bulls and the White Sox and a pioneer in meniscal and cartilage transplants. Twenty years ago, doctors would have cleaned out Schertz’s knee, helped him manage his pain and sentenced him to a life on the La-Z-Boy.

Now, using tissue from donors like Michael Collins, Dr. Cole performs 50 meniscal transplants a year and has helped more than 50 elite pro and college athletes return to the field. “In many cases, this tissue is every bit as life-saving as an organ,” Cole says. “I have patients call, crying, in pain, angry, depressed, immobile, and in a hurry for surgery. But I have to remind them to keep perspective: Someone has to die before you can get your new knee.”

Schertz waited five months for a young donor with the same weight and bone measurements. On Nov. 20, 2013, he was on Cole’s operating table at Rush University Medical Center in Chicago for the five-hour surgery to realign his tibia and replace his meniscus and cartilage.

By June, Schertz was running on an anti-gravity treadmill at 80 percent of his weight. He returned to campus in the fall and hopes to rejoin the Division II No. 1-ranked Fleming ligamentMinnesota State team next year. A registered donor himself, Schertz wants the family of Michael Collins and his own set of donors to know that the end of his chronic suffering and the continuation of his football dreams have been nothing short of life-saving.

“Not a day or a moment goes by that I don’t stop in my tracks and think about the sacrifices and losses someone else had to go through so that I could fix my knee,” says Schertz, who wept at his keyboard while composing thank-you letters to his own donors’ families. “What can I do or say to that family to justify the fact that I still get to run and play and be healthy and active and pursue my football dreams at the expense of their son?”


Tissue Donation is the Ultimate Gift

Reconstructing Ligaments Using Donated Tissue

From ESPN -The Magazine’s Dec. 8 Big Money Issue 

Carson Palmer instantly knew when he tore his ACL on Nov. 9 in a game against the Rams

Carson Palmer Hot Read

Carson Palmer’s lasting connection: By relying on donated tissue to save his knee, Palmer became one of the most high-profile beneficiaries of a fast-growing field in sports medicine: allografts. In the past decade, the use of musculoskeletal allografts — transplanting pristine replacement parts recovered from deceased human donors to repair the ravaged knees, shoulders, elbows and spines of athletes and millions of others — has quietly boomed into a billion-dollar industry, with more than 1.5 million tissue transplants each year.

English soccer star Michael Owen, Olympic snowboarder Lindsey Jacobellis, White Sox star-turned-manager Robin Ventura and UConn basketball great Caroline Doty are just a few of the hundreds of elite athletes who have come back from injury thanks to the selfless final act of a stranger. “Unfortunately, someone had to pass for my recovery to happen,” Palmer says. “If people didn’t donate, my surgery, my recovery and everything else after isn’t successful, or even possible. It’s a lot to think about, just how lucky I am.”

“There is a long, crowded history of people trying to use things to repair the body other than human tissue,” says Dr. Lonnie Paulos, Palmer’s orthopedic surgeon. “But it’s nearly impossible to fool Mother Nature.”

Donated ligament would change Palmer’s life after he tore his ACL during a game against the Steelers.

Carson Palmer Hot ReadThe biological truth at the center of the allograft industry is simple and profound: Humans aren’t just similar, we’re practically interchangeable. Unlike organs, which must be matched by blood type and antigens and transplanted immediately, tissue is universal. It can be recovered up to 24 hours after death, stored for years and reused regardless of age or sex. That explains why a Pro Bowl quarterback could have a new ACL created from the Achilles tendon of someone who seemed to be his exact opposite: a woman 11 inches shorter and 19 years older who’d never thrown a football more than 10 yards.

Of the 3 million people who die each year in the United States, fewer than one-tenth of 1 percent (14,257) become organ donors and roughly 30,000 share their tissue. Although few understand and appreciate it the way Palmer does, a donor’s ligament is a rare and valuable gift. Human cartilage, for example, does not regenerate. Without a replacement part, an athlete who tears a meniscus would have to spend the rest of his or her life with bone grinding against bone and the debilitating white-hot pain that goes along with it.

Since the late 1990s, when surgical pioneers like Dr. Paulos and Dr. Brian Cole of Chicago’s Rush University Medical Center made allografts so popular in ACL surgery that tissue banks began running out of tendons, AlloSource — managed by six regional OPOs — hasn’t been able to grow fast enough. In fact, the demand in orthopedic surgery is so high that an entire section of the company’s 30-page color catalog is dedicated to sports medicine. Dr. Brian Cole regularly performs cartilage restoration that allow patients to have full mobility.


Before donated tissue could become Palmer’s, however, it had to be sent to a tissue bank in New Jersey, where it was processed, cleaned, tested and stored. That facility is much like AlloSource outside of Denver, one of the country’s leading allograft hubs. AlloSource deals in skin grafts, full bone replacements, spinal grafts, osteobiologics and even stem cells. In conjunction with the Joint Restoration Foundation, it also distributes 225 tendons a week and nearly 240,000 allografts a year.


Navy Sailor Gets His Sea Legs

Patrick Boettger is on active duty with the United States Navy in the country of Behrain. While on a run in the middle of the desert, Patrick jumped off a two foot cliff and injured his ankle. With limited medical personnel on his base, Patrick had to endure pain for over three months before returning home to Illinois for a two week leave. Patrick found this to be his window of opportunity to get his ankle better, and overcome his injury. He began treatment at ATI Physical Therapy in Matteson, Illinois in order to return to duty. Watch Video>>

Hi, my name is Patrick. I’m currently active duty Navy, and I’m stationed overseas in Bahrain. Bahrain is a middle eastern country, mostly desert. From the Seals team, I run all of their range operations, I issue them all of their weapons. I went on a four to five mile hike, through rough terrain in the middle of the desert, when I was over there training, and I jumped off a two foot cliff, and I rolled it outwards. So after I injured my ankle, it was about three months, I found out I was coming home on leave for two weeks, and right then and there, I was like, I’m going to go somewhere and get this thing fixed, get a 100 percent. I was told to come to ATI.

To me, that’s significant, because when you think of military personnel being on leave, they need to spend time with their family, with their loved ones, with their friends, but he’s had a unique situation. He had an ankle injury that has kind of put him back, and it’s a risk for him to be injured with his type of work. The fact that he is here with us, and spending that time with us here at ATI in Matteson, to get back to what he was doing, is very significant, to not only him but to us and to be able to serve and work with Patrick.

Every single exercise they’ve shown me here, has helped out dramatically. I haven’t been able to run farther than seven paces, and today I ran seven minutes on the treadmill, and that’s only in a two week period. To me, that’s dramatic improvement. I was definitely amazed by my results I achieved in two weeks, I thought it was going to take me two to three months.

We’re just very lucky here to have met a hero from our own neighborhood, and been able to help him in a way that only we can.

ATI Physical Therapy

Former Knee Patient Paul Griggs Named Big Ten Special Teams Player of the Week

Paul Griggs became the first player in school history to kick two field goals of 50 or more yards in the same game.Paul Griggs became the first player in school history to kick two field goals of 50 or more yards in the same game.

In November of 2011, Paul had a distal femoral osteotomy, performed by Dr. Brian Cole from Midwest Orthopaedics at Rush, where is femur was cut to correct his “bow legged malalignment” and a cartilage transplant to his right knee at the age of 17.  He had aspirations to play football at Purdue where he had maintained his full ride scholarship as a starting kicker.  Read his success below where he was chosen the Big-10 Player of the week in November, 2014!

WEST LAFAYETTE, Ind. - Junior Paul Griggs has been named the Big Ten Special Teams Player of the Week. The weekly honor is the first of Griggs’ career and the first for any Boilermaker this season.

The third-year kicker booted field goals of 53, 52 and 40 yards in the Boilermakers’ tilt with Wisconsin on Saturday. In doing so, he became the first player in school history to make two field goals of 50 or more yards in the same game. Including his PAT after Akeem Hunt’s 79-yard touchdown reception, Griggs accounted for 10 of Purdue’s 16 points in the game.

Griggs also kicked a 51-yard field goal against Western Michigan on Aug. 30, to make him the first kicker at Purdue to have three field goals of 50 or more yards in the same season. His 53-yarder against the Badgers was a career long and tied him with his predecessor Carson Wiggs for the third longest in school history.

Osteotomy refers to a cut in the bone, but usually refers to a cut in the bone which is used to change the position or alignment of a bone. By changing the alignment of the leg, stress can be lessened in one area and increased in another. This repositioning or re-alignment tries to decrease the inflammation and pain in the joint and increase its life before a knee replacement becomes needed. A cut is made in the thigh bone just above the knee to allow the surgeon to straighten the knee. The cut is made from the outside (lateral side) of the leg. This is called a Distal Femoral Osteotomy. Once the bones are well aligned, the bone is fixed with a plate and screws.

Medical Commentary on Nik Wallenda’s High-wire Walk over Chicago

On Sunday, Nov. 2, daredevil Nik Wallenda completed an amazing two-part tightrope walk 50 stories above the Chicago River that broke not one, but two Guinness World Records. Without a safety net or harness, Wallenda first walked from the Marina City’s west tower to the Leo Burnett Building — a distance of more than two city blocks that rose to a 19-degree angle, the steepest angle Wallenda has ever attempted. For the second part of the walk, spanning Marina City’s west and east towers, Wallenda was blindfolded. Dr. Brian Cole from Midwest Orthopaedics at Rush, provided expert medical commentary during the Discovery Channel’s broadcast of the event, which was seen by more than 22,000,000 people (roughly 64,000 were on hand to watch live).

Watch the Interview with Dr. Cole on the Discovery Channel


Complete Transcript of Medical Commentary on the Walk to Remember

Brian Cole, MD, and Nik Wallenda


Insights into Nik Wallenda’s high-wire walk over Chicago

Brian Cole, MD, and Nik WallendaOn Sunday, Nov. 2, daredevil Nik Wallenda completed an amazing two-part tightrope walk 50 stories above the Chicago River that broke not one, but two Guinness World Records. Without a safety net or harness, Wallenda first walked from the Marina City’s west tower to the Leo Burnett Building — a distance of more than two city blocks that rose to a 15-degree angle, the steepest angle Wallenda has ever attempted. For the second part of the walk, spanning Marina City’s west and east towers, Wallenda was blindfolded.

Brian Cole, MD, MBA, a sports medicine surgeon at Rush University Medical Center, provided expert medical commentary during the Discovery Channel’s broadcast of the event, which was seen by more than 22,000,000 people (roughly 64,000 were on hand to watch live). After Wallenda completed his death-defying stunt, we asked Cole to comment. Here’s what he had to say.

Q: What insights did you offer during the telecast?

Cole: Mostly, I talked about the difference between walking on an incline and walking on a level wire, and the recovery issues Nik faced. He had only a short period of time to transition from one to the other, and that presented some unique challenges.

Muscle fatigue was one issue he had to contend with. To walk at an incline, he had to use dozens of muscles in his legs and the larger muscles of his core. Plus, he was holding a 45-pound pole with his arms bent for a prolonged period of time. We also discussed the need for recovery — physically and mentally — before starting the second part of the walk, where he was blindfolded.

Q: What additional challenges did the blindfold create?

Cole: To maintain balance and stay on the wire, there has to be integration between three systems

  • The vestibular system (the inner ear), which helps him balance and stay upright
  • Proprioception, receptors that help us perceive where our joints and limbs are in relation to each other, and controls how we move in response to where we are in space. For example, it’s this system that allows us to walk without looking at our feet but not lose our balance and fall.
  • Vision, which helps to integrate the nervous system, as it provides feedback to improve the actions of our inner ear and our proprioceptive system.

Being blindfolded — taking vision out of the equation — is like removing one leg from a three-legged stool: It changes your ability to balance and for Nik was a game-changer.

I think from a technical and difficulty standpoint, the blindfold was more challenging than the incline. Nik was definitely more nervous about that part of the feat.

Q: What role does the pole play for a tightrope walker?

Cole: Most people think the pole has something to do with lowering the person’s center of gravity. But actually, the pole is responsible for changing something called “moment of inertia,” which is a basic physics principle that relates to balance.

If you think of a figure skater doing a spin, they start with their arms extended and spin relatively slowly, but they are more stable and less likely to fall. When they pull their arms in close to the body, they spin very quickly but fall more easily.

The pole spreads the person’s mass over a wider distance, which improves stability and lowers the risk of a fall. As the pole spreads Nik’s mass away from his body, it increases his moment of inertia, much like the figure skater holding out his arms.

Q: How did Wallenda prepare for the unique challenges of this stunt?

Cole: He practiced both on an incline and blindfolded. He also had people there, while he was practicing, trying to create unpredictable movements in the wire so he could improve his body positioning.

I also commented during the telecast that Nik’s “playing field” is very different from most athletes. The wire is unlike a court or turf field. His opponent is particularly unpredictable: the unanticipated gusts of wind, weather and movement in the wire were all aspects of this unique challenge that Nik had to prepare for.

Q: What is the biggest difference between “extreme athletes” like Nik Wallenda and other high-level athletes?

Cole: Extreme athletes tend to score very low on the risk aversion scale — they have very little aversion to any risk — but they also exhibit very self-directed behavior.

That means they are intelligent, calculated, responsible and methodical. They are not stupid. They are not careless. But their levels of fear, all things being equal, are less than any normal person would have given the same level of risk.

There are certain scoring systems used to assess this type of personality. The extreme athlete has an entirely different personality profile than normal athletes have. The risk of death is not common to most sports — even sports we tend to consider dangerous, like football or rugby — but it is remains a unique aspect of those who indulge in extreme sports.

Q: What was it like for you to be part of the spectacle?

Cole: This was my first time being involved with this type of activity, and I learned a lot about the nature of the people who do this kind of thing: people who are seen as entertainers but are athletes in their own right.

It was also amazing to see how this group of people came together to pull off a $25,000,000 production that was perfectly choreographed — except, of course, for the actual walk.

People were riveted as Nik ascended the incline and then successfully concluded his blindfolded walk. It caused shivers for those of us on the rooftop as he finished his walk on edge of Marina tower. This was truly an experience that I will never forget.

Highlight Reel


Blindfold Walk

The Squatting Mistake That Hurts Your Knees

Squats get a bad rap as knee killers. Here’s how to make them joint-friendly.

by Tony Gentilcore for Men’s Health.

Whenever someone mentions that squatting hurts their knees, I ask them to show me how they squat. Ninety-nine percent of the time, a small piece of my soul dies as I watch them. I tell them: “Squatting doesn’t hurt your knees; whatever you’re doing right now hurts your knees.”

It’s a concept that other strength coaches and I try to get across to our clients. There is a proper way to squat that won’t cause harm—and then there is every other way. Unfortunately, I rarely see them executed the proper way. Let’s get one thing straight about squat form, though: There is alwaysgoing to be some forward movement of the knees when squatting. Telling someone that the knees should never go past the toes because it’s dangerous is an archaic fitness myth. It needs to die.

That said, allowing your knees to excessively move forward so that your heels come off the ground can get you into trouble. That’s when you end up placing more stress on the knees. I see this happen a lot. That’s why I utilize the box squat. Not only do they help groove a rock-solid squat pattern and keep your shins more vertical so your heels stay on the floor, but they also take stress off the knees and place more of the load on your hips.

And that’s important, because your hips are a larger, more prominent joint than your knees. They’re designed to handle larger loads. If squatting hurts your knees—and you’re not suffering from an injury—it’s because you’re making your knees do more of the work than the hips. Learning how to utilize the hips during a squat is important if you want to make them more joint-friendly. Box squats can do that.

Box squats also keep people honest with their squat depth. Some will tell you that squatting past 90 degrees is dangerous and that it places more stress on the knees. That’s another myth. Squatting through a full range of motion is healthier for the knees and makes them stronger. Here’s how to do it:

1. Start with a box that’s 14 or 15 inches high. Note: The box height can be adjusted depending on your body type. As a rule of thumb, your thighs should be just below knee level when you’re in the bottom position of the squat.

2. Perform the move without weight first. Once you get a hang of it, place the box in a squat rack, unrack the bar, and stand in front of the box with your feet slightly wider than hip-width apart.

3. Your toes should be rotated out at 15 to 30 degrees.

4. Begin your squat by breaking with your hips. Sit back while simultaneously pushing your knees out and trying to spread the floor with your feet. You don’t need to push your knees out to the point where all of your weight shifts to the outer portion of your feet. You just need your kneecaps to stay in line with your middle toes.

5. Gently touch the box—don’t plop—with your butt.

6. Reverse the movement back up to a standing position, squeezing your glutes at the top.

In order to master the pattern, repetition is key. Do box squats twice a week for six to eight weeks. On the first day, do body-weight box squats only. Perform three sets of 10 reps. After a couple of weeks, you can add a light load for two or three sets of eight to 10 reps. On the second day, use a heavier weight. Do three to four sets of four to six reps.

Ankle Braces Can Reduce The Number Of Ankle Sprains In Football And Basketball

Dev K. Mishra, M.D., President, Sideline Sports Doc, Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Brian Cole, M.D., Head Team Physician, Chicago Bulls, Professor of Orthopedic Surgery, Rush University, Chicago, IL

Key Points:

  • There is good evidence that lace-up ankle braces will reduce the number of ankle sprains in youth football and basketball
  • Athletes wearing a lace-up brace generally will not notice any decrease in sprint speed or performance
  • We have not seen any harmful effects of wearing the braces, so it makes good sense for youth football and basketball players to wear lace-up braces

basketball rolledankle2_3We see a lot of ankle sprains in our clinical practices, and if they make their way to the orthopedic surgeon’s office it generally means it was a significant injury. Severe ankle sprains can take many weeks to properly heal, can be costly to treat, and can place the athlete at risk for future ankle sprains. What then can we do try reduce the number of ankle sprains, or reduce the severity of an ankle sprain if one does happen?

One simple and cost effective option is to wear a lace-up ankle brace. These braces are effective in stabilizing the ankle in side-to-side and landing movements (the type of movements typically risky for ankle sprains) but allow excellent movement for straight ahead activities such as sprinting and jumping.

Ankle sprains are classified in three grades. A Grade 1 injury is a mild stretching or sprain and generally allows the athlete to return to full play in a couple of weeks. A Grade 2 injury is a partial tearing of the ankle ligaments and can take considerably longer and will often require physical therapy. A Grade 3 injury is a complete tear of the ligament. This severe injury can take months to recover, sometimes needs surgery, and places the athlete at risk for future sprains. If we can prevent ankle sprains, or at least reduce the number of Grade 3 injuries it will be a big benefit for the young athlete.

We have two high quality clinical studies showing the effectiveness of lace-up ankle bracing to reduce the number of ankle sprains in football and basketball. Both of these studies, by author Timothy McGuine, were published in the American Journal of Sports Medicine in 2011 and 2012. The authors tested the effectiveness of a lace-up ankle brace and injury rates in high school basketball and football players.

The results of the two studies were remarkably similar. In one study, comprised of 1,460 male and female high school basketball players, the rate of acute ankle injury was 0.47 in the braced group and 1.41 in the control (non-braced) group. In the other study, which included 2,081 male high school football players, the rate of acute ankle injury was 0.48 in the braced group and 1.12 in the control group.

In other words, using a lace-up ankle brace reduced the incidence of acute ankle injuries threefold in basketball and more than twofold in football. Also, the studies concluded there was no increased risk of knee injuries associated with wearing an ankle brace.

From our perspective it makes a lot of sense for young football and basketball players to wear lace-up ankle braces. Players tell us there is no negative effect on performance and the science shows the number of sprains can be significantly reduced. No ankle brace can completely eliminate all ankle sprains but in our experience they definitely make a difference. They are simple to put on, inexpensive, and can be used over and over. As you are finishing up football season or starting basketball season take a look at lace-up ankle braces. Your ankles will thank you for it.

The Importance of Accelerated’s Concussion Return to Play Program

Paul Schroeder – Accelerated Physical Therapy

You may have heard about the recent uproar concerning University of Michigan coach Brady Hoke sending his quarterback Shane Morris back into a game after suffering a concussion. If you haven’t, check out the gif below:

Within seconds of being hit, Morris exhibited symptoms of a concussion; he was unsteady on his feet and leaned on another player for support. Due to miscommunications on the parts of coaches, trainers and refs, Morris returned to the game. In the aftermath of this event, students and fans protested in front of University of Michigan president Mark Schlissel’s house demanding changes to the university’s athletic department. In response, Schlissel demanded a reevaluation of the athletic department and a review of safety procedures.

University of Michigan fans and students were right to be concerned for their quarterback’s—and all players’— safety. When an athlete sustains a concussion, it is imperative to provide for cognitive rest to allow for full resolution of symptoms. After the athlete remains symptom-free for 24 hours, it is not only the best evidence-based practice, but also state law to undergo exposure to various challenges before it is safe to obtain medical clearance for safe return to full sport participation. Just because symptoms disappear for 24 hours does not mean that they will not reoccur over the course of the Return to Play (RTP) protocol. The challenges included in the protocol are incremental and daily exposure to the cardiovascular, vestibular/balance, oculomotor, and cognitive systems over the course of several days.

The RTP protocol contains 7 phases:

Phase 1 includes cognitive rest. Phase 1 lasts as long as it takes for symptoms to completely disappear.  85% of concussion cases become symptom-free within 2 weeks; most symptoms subside within 2-3 days. Upon being totally free of any post-concussive symptoms, phases 2 through 7 are intended to occur on 6 successive days. Over the course of these 6 days, the degree of exertion of all above listed body systems is increased and challenged simultaneously.

Phase 2, corresponds to Clinic Day One, which includes light aerobic activity.

Phase 3, or Clinic Day Two, increases cardiovascular loading and adds body weight resistance.

Phase 4, or Clinic Day Three, incorporates dynamic movement, circuit training, head and body position changes, and initiates sports-specific movements, as well as concomitant cognitive loading.

Phase 5, or Clinic Day Four, advances dynamic sport movements and drills, cognitive loading, balance and vestibular challenges, and multiple-task activities.

Phase 6 takes place outside the PT clinic with a Certified Athletic Trainer (ATC) and the team during full-contact practice.

Phase 7 is return to game play.

It is important to understand that in order to safely progress to each successive stage, the athlete needs to be completely SYMPTOM-FREE.

The primary advantage of going through an RTP program in the clinic is the ability for the physical therapist (PT) to closely monitor the patient in a one-on-one, real-time environment. The PT is ideally suited with training in neurological, vestibular, cardiovascular, orthopedic, and balance systems to design and monitor progression through the various phases. Though RTP protocols administered by ATCs, coaches, or parents do occur, they are less than ideal from a perspective of both resources and training. In my opinion, the goal of a thorough RTP program is to sift through the “false positives” that would otherwise indicate a clearing for return to play. This is especially important in a program carried out by someone who has +30 athletes to monitor or by someone who lacks the necessary medical training in coaxing out latent symptoms.