"Medical redshirt" is a term that has crept into the vernacular of intercollegiate athletics through the years, even though the words aren't officially in the NCAA bylaws.

So what is the definition of this phrase that doesn't exist?

Actually, most who use it are confusing it with other terminology. For the most part when someone says "medical redshirt," they are referring to a student-athlete who is seeking to gain an extra year of eligibility because he or she suffered an injury or illness that prevented him or her from competing.

The official term for that, though, is the "hardship waiver."

Since many people throughout the membership aren't even sure of the correct name of the waiver, it's not surprising that what it takes to earn one also is hard for student-athletes, coaches, administrators and athletic trainers to fully comprehend.

In Division I, a student-athlete can apply for a hardship waiver if a season-ending injury or illness occurs in the first half of the season. The student-athlete, however, must not have participated in more than two contests or dates of competition or 20 percent (whichever is greater) of the institution's scheduled contests.

In Division II, a student-athlete can apply for a hardship waiver no matter when a season-ending injury or illness occurs provided that he/she hasn't participated in more than two contests or dates of competition or 20 percent of the institution's scheduled contests.

The criteria is the same for the most part in Division III, except a student-athlete must not have participated in three contests or one-third of the institution's scheduled games.

There must be documentation from a physician and the institution's athletic training staff for the waiver to be approved.

"People confuse a (hardship waiver) with a general redshirt, which means a year in which you just don't compete," said Bridget Niland, NCAA associate director of membership services. "In the case of a hardship waiver, say I play the first two games of the season and in the second game I blow out my knee, and I'm out the entire year. If there is contemporaneous medical documentation that certifies that the injury prevented me from completing the season, I can get the full season back. That's a hardship waiver."

Paper trail

Once again, the documentation must be up to date for the hardship waiver to be approved. Such a paper trail could have prevented a recent occurrence at a Division I institution where a head athletic trainer was dismissed in for allegedly falsifying medical records to earn a student-athlete an additional year of eligibility.

"It has to be in the file," said Jerry Weber, the head athletic trainer at the University of Nebraska, Lincoln. Weber also chairs the sports science and safety subcommittee of the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports. "It's fraud to go in and post-date that stuff. You have to make sure your information is correct. I'm sure there is pressure, because you have an athlete who has already redshirted who all of the sudden in his senior year comes up with an injury late in the year. They may want him to come back, but he can't."

Athletic trainers around the country say the biggest difference in filing for a hardship waiver is the emphasis on the documentation.

"Ten years ago if you were requesting a medical redshirt you just simply wrote a letter and that was pretty much it," said Ron Courson, the head athletic trainer at the University of Georgia. "Now when I send a letter, I send it out on stationery and have the attending physician send one on their stationery. Then we send copies of magnetic resonance imaging (MRI) report, surgical report, post-op rehabilitation notes; we send a tremendous volume of information to document it."

Keeping track of all the treatments for each student-athlete can seem like an endless paper trail, but it's a task that must be done diligently. leaving little margin for error.

"It's like any other medical office," Weber said. "It's not tons of paperwork, but you keep your records up to date. We have our physicians dictate their medical notes and we have notes from physicals and documentation from physicals. We have documentation on history of X-rays and MRIs, which can prove an injury. As long as you keep it up to date, it doesn't become overwhelming."

Nebraska has files dating back to the 1950s on treatment of athletes who competed for the institution, Weber said.

Other athletic trainers operate with the same approach. The only differences can be in the number of injuries they treat.

Nathan Wilder, the head athletic trainer at Division III Waynesburg College, manages more than 300 treatments and evaluations of injuries during football season alone.

"The injury surveillance system is used as the guideline for injury statistics," Wilder said. "Anybody who misses time for any reason, whether it's limited or missing a full practice, there has to be an injury report filed. There are kids who come in for treatment of muscle soreness and you put an ice pack on them. We still document that, even though it's not considered a time-loss injury. It's documented as they had pain, and we treated it."

Division III does not allow redshirting, but student-athletes may apply for a hardship waiver to gain an additional year if they meet the criteria. At any time within their four years, a student-athlete may elect to sit out a year of competition at their own behest.

"It's a stringent process," Wilder said. "We have a committee in the Presidents' Athletic Conference that makes those decisions based on documentation. They screen the whole process."

Education before application

One area in which athletic trainers are trying to make headway is educating the coaches.

Courson sent memos to the Georgia coaches and encouraged discussions during staff meetings.

"One confusing point from a coaching standpoint is practice status," Courson said. "They think even though (a student-athlete) is receiving a hardship waiver that they can go out and practice. That's technically not the case. For example, I may have an athlete who had an anterior cruciate ligament reconstructed in the summer, and he's not ready to play in the fall. We can do some functional rehabilitation with him -- he may be able to wander out to football practice and do some exercises on the side. But it's not permissible for him to practice with that team or he jeopardizes his hardship waiver year."

The athletic trainers also try to avoid waiver applications that have very little chance of being granted. There may be pressure to apply for a waiver, but that is another area in which athletic trainers are trying to educate coaches.

"We've had coaches here who've said if you have an athlete who played one game past the 20 percent mark let's submit it anyway," Weber said. "Well, no. It's unwise to submit it. That's when we ask the compliance people to step in and explain to the coach that it isn't going to fly. It's in black and white. You don't change things that are written down as rules. You know when your odds are good."

Most athletic trainers know that the amount of paperwork coming to the national office is immense, and they are careful not to add any frivolous waiver requests to the number of legitimate inquiries.

Overall, the Association hopes that educating student-athletes, coaches and athletics administrators -- and keeping athletic trainers up to date on the hardship waiver -- can help clarify matters and ease tensions on campuses around the nation.