OpiCalc

1121 Clinical Tools

ACL Graft Choice Risk Factors ACL-RSI Calculator (Return to Sport Readiness)AHA Pre-Participation Screening AOFAS Ankle-Hindfoot Scale ASES Elbow Score ASES Shoulder Score Acute:Chronic Workload Ratio (ACWR)Altitude Gain Guidelines Ankle Syndesmosis (High Ankle Sprain)Athlete's Heart vs HCM Beighton Score (Joint Hypermobility)Borg CR-10 Scale Borg RPE Scale (6–20)Brighton Criteria (BJHS)Buffalo Concussion Treadmill Test (BCTT)Child SCAT6 (Age 8–12)Commotio Cordis Protocol Cumberland Ankle Instability Tool (CAIT)DASH (UE Disability Index)Doha Groin Agreement ESC HCM SCD Risk Score ESC Pre-Participation Screening Energy Availability Calculator FAI Syndrome (Warwick)FAOS (Foot and Ankle Outcome Score)Fear-Avoidance Beliefs Questionnaire (FABQ)Female Athlete Triad Risk Foot Posture Index (FPI-6)Foot and Ankle Ability Measure (FAAM)Functional Movement Screen (FMS)Graduated Return-to-Play (GRTP) Protocol HAGOS (Hip and Groin Outcome Score)Hamstring Asymmetry Index Heat Index (Apparent Temp)Hip Outcome Score (HOS)Hooper Index (Athlete Wellness)I-PRRS (Psychological Readiness)IKDC (Objective Examination)IKDC (Subjective Knee Evaluation)Injury Severity KJOC Shoulder & Elbow Score KOOS (Knee Outcome Score)KOOS-PS (Physical Function Short Form)Kujala (Anterior Knee Pain Scale)LEAF-Q (LEA Screening)Lake Louise AMS Score Limb Symmetry Index (LSI)Little League Elbow Grading Lysholm Knee Score Marx Activity Rating Scale (MARS)Mayo Elbow Performance Score (MEPS)Modified Schober Test NEXUS C-Spine Criteria Neck Disability Index (NDI)One-Rep Max Estimator Osgood-Schlatter Severity Oswestry Disability Index (ODI)Ottawa Knee Rules Oxford Elbow Score Oxford Shoulder Score PAR-Q+ Readiness Questionnaire PARS-3 Youth Readiness Patellar Instability Severity Score Pitch Smart Guidelines (USA Baseball)Pittsburgh Knee Rules Post-Concussion Symptom Scale (PCSS)QuickDASH (Shoulder & UE)RED-S CAT (Clinical Assessment)Re-injury Anxiety Inventory (RIAI)Relative Age Effect (RAE)Return-to-Play Battery SANE Score (Single Assessment)SCAT6 (Sport Concussion Assessment Tool 6)SCOAT6 (Sub-acute and Office Follow-up)SEAQ-I Appetite Questionnaire STarT Back Screening Tool Session RPE (Internal Load)Sever's Disease Activity Single-Leg Hop Test Battery Standardized Assessment of Concussion (SAC)Steroid Equivalence Calculator Stinger / Burner Grading Sweat Rate and Rehydration TSK-11 (Tampa Scale for Kinesiophobia)TUE Criteria Checklist Tanner Stage Assessment Tegner Activity Scale (TAS)Training Monotony and Strain UCL Injury Risk (Medial Elbow)VISA-A (Achilles Tendinopathy)VISA-P Scale (Patellar Tendinopathy)VO2 Max VOMS (Vestibular/Ocular-Motor Screening)WADA Prohibited List Checker WBGT (Wet Bulb Globe Temp)WORC (Rotator Cuff Index)WOSI (Shoulder Instability Index)Wilks Score (Relative Strength)Wind Chill Index hEDS Diagnostic Criteria (2017)iHOT-33 (International Hip Outcome Tool)

Recent Journal Updates

WHO NewsApr 22, 2026

WHO certifies the Bahamas for eliminating mother-to-child transmission of HIV

Why this matters

Broad domain relevance to Buffalo Concussion Treadmill Test (BCTT).

Intensive Care MedicineApr 20, 2026

Temperature control in acute brain injury

Why this matters

Broad domain relevance to Buffalo Concussion Treadmill Test (BCTT).

DiabetologiaApr 15, 2026

Nature vs nurture of glucose homeostasis trajectories in children from the ALSPAC study

Why this matters

Broad domain relevance to Buffalo Concussion Treadmill Test (BCTT).

Buffalo Concussion Treadmill Test (BCTT)

Start New BCTT

Baseline Symptom Score (0–10)

Guidelines & Evidence

Clinical Details

Section 1

When to Use

Assessment of physiological recovery and exercise tolerance post-concussion.

Prescription of aerobic exercise ("The Buffalo Protocol") for symptomatic athletes.

Differentiating concussion from other conditions (e.g., cervicogenic headache) in the sub-acute phase.

Absolute Contraindications

Acute symptomatic phase (first 24–48 hours).

Cardiovascular disease or pulmonary instability.

Cervical spine instability or significant vestibular vertigo preventing safe walking.

Inability to communicate clearly.

Section 2

Formula & Logic

Test Protocol

Warm-up: 2 mins at 0% incline at a brisk walking speed (e.g., 3.2–3.6 mph).

Incline Increase: Increase incline by 1% every minute while maintaining speed.

Monitoring: Record HR, RPE (6-20 scale), and Symptom Severity (0-10) every minute.

Termination: Stop when a significant symptom increase occurs OR volitional exhaustion.

Stopping Threshold (Symptom Exacerbation)

The test is stopped if the overall symptom severity increases by ≥3 points from the pre-test baseline.

Section 3

Pearls/Pitfalls

Physiological Rationale

Concussion often causes autonomic nervous system dysfunction, leading to limited cerebral blood flow regulation during exercise. Identifying the Heart Rate (HR) threshold where symptoms resolve allows for safe, sub-threshold aerobic training that accelerates recovery.

Clinical Pearls

The test helps rule out "malingering" as symptom provocation is physiologic and linked to HR.

Allows for the creation of a "Return-to-Play" exercise prescription (80% of the threshold HR).

Passing the BCTT (reaching max HR without symptoms) is a strong indicator of physiologic readiness for full contact.

Section 4

Next Steps

Exercise Prescription

Identify Threshold HR: The HR at the moment the test was stopped due to symptoms.

Calculate Training Zone: Prescribe aerobic exercise at 80% of the Threshold HR for 20 mins/day.

Progression: Increase the target HR by 5–10 bpm every 1–2 weeks if symptoms do not worsen.

Related Tools

SCAT6

SCOAT6

GRTP Protocol Tracker

Section 5

Evidence Appraisal

Key Study

Use of graded exercise testing in concussion and return-to-activity management.

Leddy JJ et al. • Current Sports Medicine Reports. 2013;12(6):370-376. Detailed protocol and clinical utility analysis.

View Source

Last Comprehensive Review: 2026

Related Sports Medicine Tools

Standardized Assessment of Concussion

Post-Concussion Symptom Scale

Graduated Return-to-Play

ACL-RSI Calculator

Fear-Avoidance Beliefs Questionnaire

TSK-11

Have feedback about this calculator?Let us know.

Recent Journal Updates

WHO NewsApr 22, 2026

WHO certifies the Bahamas for eliminating mother-to-child transmission of HIV

Why this matters

Broad domain relevance to Buffalo Concussion Treadmill Test (BCTT).

Intensive Care MedicineApr 20, 2026

Temperature control in acute brain injury

Why this matters

Broad domain relevance to Buffalo Concussion Treadmill Test (BCTT).

DiabetologiaApr 15, 2026

Nature vs nurture of glucose homeostasis trajectories in children from the ALSPAC study

Why this matters

Broad domain relevance to Buffalo Concussion Treadmill Test (BCTT).

Buffalo Concussion Treadmill Test (BCTT)

Start New BCTT

Baseline Symptom Score (0–10)

Guidelines & Evidence

Clinical Details

Section 1

When to Use

Assessment of physiological recovery and exercise tolerance post-concussion.

Prescription of aerobic exercise ("The Buffalo Protocol") for symptomatic athletes.

Differentiating concussion from other conditions (e.g., cervicogenic headache) in the sub-acute phase.

Absolute Contraindications

Acute symptomatic phase (first 24–48 hours).

Cardiovascular disease or pulmonary instability.

Cervical spine instability or significant vestibular vertigo preventing safe walking.

Inability to communicate clearly.

Section 2

Formula & Logic

Test Protocol

Warm-up: 2 mins at 0% incline at a brisk walking speed (e.g., 3.2–3.6 mph).

Incline Increase: Increase incline by 1% every minute while maintaining speed.

Monitoring: Record HR, RPE (6-20 scale), and Symptom Severity (0-10) every minute.

Termination: Stop when a significant symptom increase occurs OR volitional exhaustion.

Stopping Threshold (Symptom Exacerbation)

The test is stopped if the overall symptom severity increases by ≥3 points from the pre-test baseline.

Section 3

Pearls/Pitfalls

Physiological Rationale

Clinical Pearls

The test helps rule out "malingering" as symptom provocation is physiologic and linked to HR.

Allows for the creation of a "Return-to-Play" exercise prescription (80% of the threshold HR).

Passing the BCTT (reaching max HR without symptoms) is a strong indicator of physiologic readiness for full contact.

Section 4

Next Steps

Exercise Prescription

Identify Threshold HR: The HR at the moment the test was stopped due to symptoms.

Calculate Training Zone: Prescribe aerobic exercise at 80% of the Threshold HR for 20 mins/day.

Progression: Increase the target HR by 5–10 bpm every 1–2 weeks if symptoms do not worsen.

Related Tools

SCAT6

SCOAT6

GRTP Protocol Tracker

Section 5

Evidence Appraisal

Key Study

Use of graded exercise testing in concussion and return-to-activity management.

Leddy JJ et al. • Current Sports Medicine Reports. 2013;12(6):370-376. Detailed protocol and clinical utility analysis.

View Source

Last Comprehensive Review: 2026

Related Sports Medicine Tools

Standardized Assessment of Concussion

Post-Concussion Symptom Scale

Graduated Return-to-Play

ACL-RSI Calculator

Fear-Avoidance Beliefs Questionnaire

TSK-11

Have feedback about this calculator?Let us know.