King of Prussia---I'm looking forward to attending this year's Combined Sections Meeting nexk week in (what we hope is) sunny San Diego! It will be a nice change of pace from last year's meeting, which was a lot of fun, but also quite chilly in the Windy City. We here at ADVANCE's offices in the Philly suburbs need warmth--and fast!

While members of the ADVANCE team were in San Diego in 2010 for that winter meeting, the last time I was there was in 2006 for CSM--and it was memorable for many reasons. The night before my flight out, my twin sister Angela gave birth to her triples, my two nieces and nephew. It was a crazy day, leaving work, driving with my family to the hospital and waiting to see that the babies were OK and that my sister was doing well. It made for a long night, then a long flight. The conference was a lot of fun and interesting as it always is, but to say I went through the week a bit distracted was an understatement.

This year promises a lot of great information and a lot less drama!  I am especially looking forward to networking with people I've come to feel are my "colleagues," who contribute to ADVANCE in many ways and who help keep our magazine by PTs, for PTs. And from what I hear there is a lot to do in San Diego; in 2006 I was fortunate enough to get to see the famed San Diego Zoo (and the adorable baby pandas!!) Perhaps a visit back? Or something new...

Please stop by ADVANCE's booth #717 if you can to chat, and bring us any questions you have. Hope to see you there!

The following blog is a guest post by Elizabeth Rosto Sitko, managing editor of ADVANCE for Long-Term Care Management, our sister publication: 

Last week, Newsweek published its final print issue. As a magazine enthusiast (I subscribe to many, I've studied them, and I work for one), I was saddened to hear the news. I remember a time when finding one of my favorite magazines in the mail meant I would be sitting on the couch for the rest of the night to read it from cover to cover.

But times change, and the reality is that more and more publications are moving away from print formats and going online only. There are various reasons for this, including readers' preferences. Many don't want to carry around stacks of paper, and enjoy being able to read all of their favorite articles right from their very own laptop, tablet or smartphone.

I have to admit that I no longer subscribe to our local paper, The Philadelphia Inquirer, because it's more convenient and less expensive to read it online. Luckily, your subscription to ADVANCE has always been and always will be free. And you still have your choice of reading the traditional paper version or our digital edition.

So, which do you prefer? To make sure it keeps coming (either to your mailbox or inbox), please update your contact information on an annual basis here.

Pate Rehabilitation, Dallas, TX, issued a press release Nov. 28 announcing the launch of a new Spanish program as part of its evidence-based treatment and support for individuals recovering from acquired brain injuries. According to the release, "this comprehensive linguistic and cultural approach maximizes the benefits of brain injury rehabilitation for patients in the Hispanic community, including monolingual Spanish speakers and bilingual individuals."

According to the 2010 US Census report, more than 16 percent of the US population is of Hispanic origin, the release continued. "The majority of this group speaks Spanish as their primary language and, therefore, may experience a disadvantage in medical care provided in English."

Pate's Spanish treatment team is bilingual and receives specialized training in the linguistic and cultural issues that may impact the process of rehabilitation and recovery from brain injury. The company extends its therapy sessions into Spanish-speaking environments, enabling patients to practice skills in their own cultural communities. Additionally, Pate provides support groups and family conferences entirely in Spanish.

How about you, ADVANCE readers? Have you noticed an increase in the number of Spanish speakers among your patient population in recent years? Has your hospital or clinic implemented measures similar to those taken by Pate Rehabilitation? Feel free to share the details.

Unless Congress passes legislation, there will be a therapy cap with no exceptions process for all outpatient therapy settings except hospitals effective Jan. 1, 2013. Therapy caps, or established per-person Medicare spending limits, for nonhospital outpatient therapy, were first established by Congress in 1997 under the Balanced Budget Act (BBA).

Under these caps, Medicare covers a set dollar amount for outpatient physical therapy, occupational therapy, and speech-language pathology services. The current therapy cap is a combined $1880 for PT and SLP, and a separate $1880 for OT.

Congress has recognized the harm the therapy caps would cause and has voted several times to keep the caps from going into effect. Most recently, Congress voted to extend the therapy caps exception process through December 31, 2012. But will Congress do it again? That is the big question.

What is so bad about the therapy cap? For one, the cap limits Medicare patients to roughly two months of treatment at an outpatient therapy clinic. Imagine your 75-year-old father is recovering from a stroke-once his Medicare therapy cap is reached, his options are to forgo care, pay out of pocket or travel to an outpatient hospital clinic (which may be a long distance from his home) for continued care. This doesn't seem right when most stroke patients continue to make gains many months-or even years-after the initial event.

Unless Congress acts, the current therapy cap exceptions process will expire on Dec. 31, 2012.

There are many ways to get involved and time is of the essence:

• Use ASHA's Take Action site to contact Congressional representatives and ask them to repeal the therapy caps
• Check out the Stop the Medicare Therapy Cap Facebook page 
• Visit APTA's Take Action to Stop the Cap
• Visit the AOTA Legislative Action Center

As the calendar flips to mid-November, road racing opportunities begin to dwindle in the Northeast. With decreasing daylight and increasing cold, most runners will do their best to keep in shape over the winter months and then jump back into racing come the spring. In ADVANCE's backyard, the Philadelphia Marathon marks a symbolic point near the end of the popular racing season and will be held Sunday, Nov. 18. Neither as old as the Boston Marathon nor as big as the New York City Marathon, the Philly Marathon has nevertheless carved out its own charming niche.

Founded in 1954, its scenic course winds past historic landmarks like Independence Hall, the National Constitution Center and Liberty Bell, through urban neighborhoods and along the waterfronts of the Delaware and Schuylkill Rivers. This year the race and its companion half-marathon sold out nearly two months in advance, with 27,000 total runners registered to take the starting line. This is the highest total in event history and will become still larger since the city recently opened 3,000 emergency slots for runners who signed up for the 2012 New York Marathon, which had to be canceled due to the tragic effects of Hurricane Sandy.

The booming popularity of marathon running in the City of Brotherly Love is indicative of a nationwide trend over the past decade. People who had previously been only casual runners become fascinated by the idea of completing a marathon, or even a half-marathon, and pile on miles of training in the months leading up to their race. Overuse injuries can often result, creating a need for physical therapy. Some PT practices cater specifically to runners, and many running patients like the idea of being treated by somebody who is also a runner. Do you frequently treat marathoners? Are you a marathoner yourself? What do you like most about this population?

As President Obama has won a second term in office, the Affordable Care Act will now be going into effect in January of 2014. Several states have filed appeals or injunctions for waivers to opt out of all or some parts of the health care plan, but the decisions on those rulings have yet to be determined.

Proponents of the Act say that health care costs across the board will go down for most Americans, and that the Act will provide more options for health insurance at lower costs. The implementation of the Act will seemingly override the need for a Medicare cap on outpatient therapy, which still stands at $1,880 for physical therapy (PT) and speech-language pathology (SLP) services combined, and $1,880 for occupational therapy (OT) services.

Recent changes to the caps began October 1, 2012; Medicare contractors can review patients' medical records to check for medical necessity if a patient got outpatient therapy services in 2012 higher than $3,700 for PT and SLP combined, or $3,700 for OT.

Also as of October 1, 2012, the exemption ends and the outpatient therapy caps will apply to therapy services patients get in an outpatient hospital department or hospital emergency room and count toward the therapy cap limits. Source: http://www.medicare.gov/Pubs/pdf/10988.pdf

Combined with these recent changes, what do you think the impact will be once the Affordable Care Act goes into effect? Do you have more positive or negative feelings about your practice-in whatever capacity you work-now that the election is over?

The APTA issued a press release on Oct. 12 about a recent study published in the journal Neurology and conducted in the Greater Cincinnati/Northern Kentucky region. Researchers found that the rate of strokes among adults younger than 55 years of age increased from 12.9 percent in 1993/1994 to 18.6 percent in 2005.

Stroke incidence rates in people age 20 to 54 were significantly increased in both black and white patients in 2005 compared with earlier periods. The investigators also found that the mean age at stroke significantly decreased from 71.2 years in 1993/1994 to 69.2 years in 2005. Possible explanations for the increase could be that physicians are detecting strokes in young people more often, both as a result of better imaging technology and more vigilant screenings, according to a Reuters Health article about the study.

"But I really don't think that's the major reason," lead researcher Brett Kissela told Reuters. "We're definitely seeing a higher incidence of risk factors for stroke now."

With people developing obesity, diabetes and high blood pressure at a younger age, they also are increasing their risk of stroke at a younger age.

"This is of great public health significance because strokes in younger patients carry the potential for greater lifetime burden of disability and because some potential contributors identified for this trend are modifiable," the authors wrote.

It's certainly a topic of concern and was also the focus of a Sept. 17 ADVANCE cover story, "Brain Attack," which chronicled the experience of an otherwise fit and healthy 37-year-old woman in Massachusetts who unexpectedly sustained a stroke.

What are your thoughts on this study? Have you seen evidence of stroke striking younger adults in your practice?

It's easy to ‘think pink' by supporting national organizations that are fighting for a cure during National Breast Cancer Awareness Month. There are endless ways to support the cause whether you love to shop, attend events, walk or run.

Do you enjoy lifting your spirits with retail therapy? If so, each year there are more and more products available with some-or even all-proceeds going to breast cancer.

Hollywood stars-many of whom are breast cancer survivors themselves-team up with designers to offer special products ranging from ASICS with Christina Applegate running shoes for $100 to LOFT with Giuliana Rancic Live in Pink necklace for $69.50.

ASICS guarantees $75,000 donation (up to $100,000) to Applegate's Right Action for Women Charitable Initiative, which educates increased-risk women about cancer screenings while LOFT will give 25% of proceeds to the Breast Cancer Research Foundation.

Instead of heading to the nail salon, you can pick up the ORLY Pretty in Pink nail polish collection, $10 each, with 25% of the profits benefiting Fran Drescher's Cancer Schmancer, encouraging breast cancer prevention, education and early detection.

Also keep a lookout for pink ribbon merchandise that is available through research centers like Susan G. Komen for the Cure and the Breast Cancer Awareness Pink Ribbon Shop.

Or maybe there's a loved one you would like to send a note to? And I'm not talking about drafting an email, I'm talking about snail mail! You can support breast cancer research by using a stamp commemorating breast cancer, sold by the U.S. Postal Service for the past 15 years. So far, the agency has raised more than $75 million for research programs at the National Institutes of Health and the Department of Defense.

Feel like lacing up? The annual Making Strides Against Breast Cancer Walk is organized nationwide by the American Cancer Society. More than 8 million people have walked for this cause and raised about $460 million.

You can join people from four continents for one of the increasingly popular Race for the Cure events organized by Susan G. Komen For The Cure or an Avon Walk For Breast Cancer event organized by the Avon Foundation for Women.

In addition to raising funds and awareness for the fight against breast cancer, these organizations and events celebrate breast cancer survivorship and honor those who have lost their battle with the disease.

Be sure to check back for our October 15^th cover feature "Survivorship Services" for more on breast cancer and the role of rehabilitation.

What will you do this month to bring the cure for breast cancer just one step closer? 

I had an extended phone conversation recently with a practice owner in the Midwest. I'd called to interview him about a separate subject but we ended up spending most of our time chatting about the challenges facing the independent practice owner in his particular market. This gentleman -- who has years of experience owning a therapy business -- is witnessing first-hand the effects of a large local hospital system opening its own in-house hospital-owned physical therapy service (HOPTS), and encouraging its physicians to refer patients to it.

In some cases, the practice is subtle; in others, it's downright blatant. This practice owner's sister had a procedure performed in the hospital recently that necessitated physical therapy. Upon being discharged, the scheduling secretary wouldn't let her leave the office without scheduling her physical therapy appointment. Only because this patient happened to have a brother in the industry did she understand her patient rights fully, and make it forcefully known that she would be pursuing her therapy elsewhere. If this had been another patient, especially one not familiar with physical therapy and how the referral process works, it would be one fewer referral to an independent PT practice.

And it doesn't stop there. The gentleman I spoke with is an entrepreneurial-minded practice owner who has launched specialty programs through the years that his community has embraced and responded to. But every time he announces a new niche service, the hospital system blunts the move by opening a bigger, better-equipped one -- a million-dollar wellness building; a high-tech sports performance program for local school-aged athletes with the exact same program name.

He even had to give up his contract providing athletic training coverage to two local school districts, for which he was paid a nominal fee, when the hospital swooped in and offered to provide the same service -- plus all medical equipment -- to the school district for free.

"They're using it as another way to gold-mine patients," he said of the school district contract.

When I posed the question of whether his state PT association was aware of the issue, or has taken any steps in response, he lamented that probably 90 percent of licensed PTs in his state are hospital-based anyway, so they don't see it as a priority.

Some would say, that's just the way business is going in America. After all, how many mom-and-pop hardware stores or independent furniture retail outlets do you see anymore? Are we naïve to think that the health care market would be somehow immune to big-box centers stifling the independent businessperson?

The owner that I spoke with, who will be retiring soon and has a succession plan in place for his partners, takes the high road. He's not anti-business nor anti-expansion, and even recognizes that monopolies aren't all bad, as long as they recognize that they're monopolies and act ethically. But I couldn't help but feel that the pride of PT ownership is somewhat diminished when the corner physical therapy practice has to close up shop.

Have you felt any first-hand effects of HOPTS in your area?

Physical therapists who haven't been paying attention to the legislative battle raging in California might want to start. As the APTA detailed in its Aug. 30 press release, "In California, a Rough Ride for Senate Bill 924," the latest salvo was just fired:

"California physical therapists have been infuriated by the legislative wrangling that California SB 924 has been subject to during the past two weeks, made all the more frustrating because the bill is stalled in the Assembly Rules Committee during this last week of the California legislative session. The legislation, a compromise bill brokered by California Senate President Darrell Steinberg and sponsored by state Sen. Curren Price, was intended to end a long and bitter battle in the state legislature between the California Chapter and the California Medical Association (CMA) over the issues of direct access to physical therapist services, and whether PTs may be employed by, or be shareholders of, medical corporations, and alternatively whether physicians may be employed by or shareholders of PT corporations. While the chapter supported the direct access elements of SB 924, it was not in favor of the corporation aspect of the bill. Conversely, CMA supported the corporation language in the bill and remained adamantly opposed to allowing direct access."

For the most part, the legislation had been moving without major incident through the California legislature, the press release continued. SB 924 passed the Senate unanimously on Jan. 30, and passed the Assembly Business & Professions Committee on June 26. 

"The flare-up started on Aug. 16, when SB 924 passed unanimously out of the Assembly Appropriations Committee, but not before the committee made hostile amendments to the direct access aspects of the bill behind closed doors, without input from the California Chapter or the bill's chief sponsor, Sen. Price. Under the prior compromise version of SB 924, a signed plan of care from a physician or podiatrist was required to continue treatment after the initial 30 business days or 12 visits provided via direct access; the physical therapist also needed to provide written disclosure to the patient explaining the provisions tied to the direct access law. As amended by the Assembly Appropriations Committee, a diagnosis from a physician or podiatrist must be obtained after the initial 30 business days or 12 visits via direct access in order to continue treatment. The disclosure language the PT must provide to the patient also was amended to add language stating the private insurance may not pay for the services without a physician referral. The amendments made by the Appropriation Committee were held from the public for five days before being released, causing an uproar."

The bill took another turn on Aug. 24, when the amendments placed into SB 924 during the Assembly Appropriations Committee hearing were removed on the Assembly floor, while new "unwelcome" amendments were added. But shortly thereafter, Assembly Speaker John A. Pérez referred SB 924 to the Assembly Rules Committee, a "procedural stall tactic," where SB 924 may stay until the end of the legislative session. If SB 924 is not moved from the Assembly Rules Committee and sent to the Assembly floor for a full vote by midnight on Aug. 31, SB 924 will die. The California Chapter is urging its members to contact their Assembly member to ask for an up-or-down vote on SB 924 by the full Assembly before the midnight deadline. The full text of the current version of SB 924 can be found here.

Student athletes are continually thinking about how they can be faster and stronger than the year before. But with so many recent headlines about sudden death in young athletes, programs that teach students to safely perform better on the athletic field are at a premium. The experts at Performance Speed School in Rhode Island teach young athletes how to increase their speed, strength and flexibility for a better performance on the athletic field.

Focused on making athletes faster and stronger, the Speed School leaders include certified youth fitness instructors, strength and conditioning specialists, physical therapists and athletic trainers. The skills taught in this program help young athletes excel above their competition and decrease the risk of injury.

Kevin Silvia, BS, PTA, CSCS, FMS-C, and Adam Ware, BS, CSCS, FMS-C, of Performance Physical Therapy ran a Speed School clinic last spring for the West Warwick Wizards girls' basketball team.

The 1.5-hour session began with a welcome talk and dynamic warm up stretches and drills. As Silvia took the girls through various drills, he explained the difference between static and dynamic stretches and why it's important that they understand.

Silvia instructed the basketball players to perform stationary and dynamic field drills for 30 seconds with a rest between and plyometric exercises such as squat jumps, all while emphasizing technique. For example, if he saw an athlete leaning forward during walking knee raises, he adjusted her posture and explained why it's important to use the core to power the move. Additionally, he encouraged form over speed and constantly reminded the students to "take it slow."

Next Silvia and Ware set up two stations for the team. One half of the basketball players performed planks and sit-ups for one minute while the other group bounced volleyballs off the wall. The groups quickly traded places when Silvia and Ware blew a whistle to indicate a transition.

In addition to teaching the athletes safe ways to gain speed and strength, Ware and Silvia "train" coaches on the drills. Wizards' Head Coach Brad Grossguth told ADVANCE "the information they have given me helps prevent injuries on my team by teaching proper landings while emphasizing speed and form."

According to Assistant Coach Mike Petrarca, it's often helpful for the athletes to hear the same information from a new person. "It helps to reinforce the message," he shared.

"Adam and Kevin help the kids understand the drills and why they are doing them," explained Coach Grossguth.

On a related note, please be sure to check out an article in our Sept. 3 issue about new guidelines for young athletes released by the National Athletic Trainers' Association (NATA), in collaboration with the National Strength and Conditioning Association (NSCA).

McKayla Maroney is certainly talented and adorable -- but also tough as nails. You can say that about her teammates as well: Jordyn Wieber, Aly Raisman, Gabby Douglas and Kyla Ross. Together they blew away the rest of the world yesterday in London to win the first Olympics team gold medal for USA Women's Gymnastics since 1996. That team from the Atlanta Games was known as the "Magnificent Seven" and has been forever immortalized by Kerri Strug's astonishing one-legged vault landing while favoring a badly sprained ankle.

There is a parallel between Strug and Maroney, who competed yesterday with a fractured big toe that she aggravated last week in training. Maroney is also the world's premier vaulter, who soars "about two feet higher than any other girl in the competition" according to NBC gymnastics analyst and former Olympian Tim Daggett.

Great concern pervaded the Team USA camp about Maroney's ability to perform this week. She won the vault at last year's World Championships, where the USA also scored the team gold by a wide margin. Those performances had placed a target squarely on the backs of Maroney and her teammates for this year's Olympics. The pressure was intense, not to mention the shadow cast by that 1996 team over all American women's gymnastics squads that have followed it. But Maroney was undeterred.

"Bad things happen, you just have to make the best of it," she told NBCOlympics.com. "It does hurt. It's broken. How is it not going to hurt? I just try to ignore it and I have worked so hard to be here."

She was true to her word. Team USA threw down the gauntlet to the rest of the world in the opening event yesterday -- the vault. Wieber and Douglas each nailed their difficult attempts before Maroney brought the crowd to its feet with a thrilling and seemingly flawless vault. The announcers openly speculated that it could achieve a perfect score of 16.5. Daggett was in disbelief that it "only" earned a 16.233 -- still by far the best vaulting score at the Games.

USA Team Coordinator Martha Karolyi later said, "It. Was. The. Best. Vault. Ever."

Team USA gained a lead it would never relinquish thanks to this tremendous opening salvo from Wieber, Douglas and Maroney. The gold-medal winners constituted a team in the truest sense of the word. Maroney fighting through the pain to dominate in her signature event. Wieber bouncing back from the disappointment of not qualifying for the all-around individual competition by emphatically scoring in three team events. Ross stepping up to compete in Maroney's place for the uneven bars, balance beam and floor exercise. Douglas showing her versatility by being the only team member to perform in all four events. And captain Raisman clinching gold with the final floor exercise, knowing full well that only a botched routine from her could keep the team from claiming the gold it had all but assured at that point. She actually started crying just seconds from the end, aware she had passed the difficult tumbling runs with flying colors and her team's rise to the top of the podium was now destined.

There is a famous hockey story that prior to game 6 of the 1974 Stanley Cup Finals, Philadelphia Flyers Coach Fred Shero wrote a message to his team on the locker room blackboard: "Win together today and we walk together forever."

The 2012 USA Women's Gymnastics Team will certainly walk together forever now, remembered as Olympic champions and among the greatest ever. To quote another American legend, Bruce Springsteen, here is my own salute: "Born in the USA!"

With the Summer Olympics in full swing, attention has understandably been drawn to the swimming accomplishments of American hopefuls Michael Phelps and Ryan Lochte. But back on United States soil -- or rather in U.S. waters -- another swimmer is making waves.

38-year-old Craig Dietz competed in the Pittsburgh Triathlon this past weekend as part of a three-man relay. Dietz, who was born with stubs for arms and legs, finished the 1.5k swim in the Allegheny River in 29:16. The time was a personal best.

Despite being born without limbs, Dietz was a very active kid and began swimming at an early age. He also bowled in a league and enjoyed hunting, fishing, playing percussion in the school band, and was a member of the High School honor society.

"Bob," the name of the relay team, is an example of Dietz's lighthearted approach to life. As Dietz likes to joke, Bob is what you call a man in the water who has no limbs.

Dietz first competed in the Pittsburgh Triathlon in 2008 and immediately became hooked on the competition of triathlon and open water swimming. In 2010, Dietz finished the swim in 30:14, beating 140 able-bodied competitors.

Last month, Dietz competed in the Great Chesapeake Bay Swim, a grueling 4.4 mile swim, for the second time.

As a former competitive swimmer, I can appreciate the training, dedication and skill that contribute to his many accomplishments. As much fun as it is to watch Olympic records being smashed, I personally cannot wait to see which body of water Dietz conquers next.

At the 63^rd Annual Meeting and Clinical Symposia of the National Athletic Trainers' Association -- held June 26-29 in St. Louis -- presenter Kenneth Chew, PsyD, outlined the immense pressure today's young athletes are under during "A Whole New Ballgame: Interdisciplinary and Interdepartmental Approach to Health Care and Health Promotion of College Student-Athletes."

"It's much different [now] than how it may have been 10 to 20 years ago," said Chew, Director of the Indiana State University Student Counseling Center in Terre Haute, IN. Fueled in part by pressures of high-dollar scholarships and dreams of making it big like the superstars on TV, today's young athletes are taking on tremendous pressures earlier in their sports careers. Plus, helicopter parenting and colleges catering to their star athletes have created a sense of entitlement and taken away many of the adult-level responsibilities that teach valuable coping mechanisms to adolescents and young adults.

"Students are coming in with a less-defined sense of personal identity," said Chew.

Adding to this is today's detached social environment, which stresses electronic communication over interpersonal skills. As a result, students can be more sensitive to criticism and less likely to assert themselves.

"When they were growing up, everyone got a trophy," said Chew.

Taken as a whole, the perfectionistic tendencies, higher standards and less-developed social and coping mechanisms are pushing many of today's student-athletes to the brink. Psychotropic medications have exploded in recent years, Chew reported, and student counseling centers have seen a 10% to 25% increase in usage over the past 10 years.

For this reason, a college's athletic department should keep a close watch on the emotional states of its athletes, and shouldn't hesitate to alert trained counselors, Chew stressed. Doing so could save a life.

"If a student is suicidal, chances are you'll see it before me, and in some cases [even] before the coaches," Chew told his audience of physical therapists and athletic trainers. Open communication between the athletic department and the university's counseling/mental health service is critical to keep problems from falling through the cracks, and to prevent assumptions that the case is being handled by another department.

"Without that regular communication, there is confusion about what each other does," Chew said.

The "Fortnight" ended with high drama on Sunday, as Roger Federer won his record-tying seventh Wimbledon championship in a thrilling four-set match over Scotsman Andy Murray, who was trying to become the first British male to win Wimbledon since 1936. Clay Sniteman, MSPT, ATC, owner of Sundance Physical Therapy in Ogden, UT, was there -- working as a physical therapist and athletic trainer for the Association of Tennis Professionals (ATP). He penned this dispatch for ADVANCE from the All-England Club shortly before the final:

"It's just about a wrap. Another Wimbledon. Another year. Another name just about to go down in the history books.

The grass has seen it all. Heartache from double faults, jubilation from passing shots and enough emotion to buy the Queen's jewels. Prince William and Kate were courtside along with enough celebrities to satisfy even the most jaded paparazzi. Canons and Nikons were even competing.

But, it's just about a wrap now.

As I go out to see the once pristine courts, brown spots have now appeared -- a tribute to those that laid it all out. But as bruised as the grass seems now, right after the final celebration, a master will go out and massage the places that have been rubbed raw. They know just what to do. They will give the grass time to heal, supply the right amount of TLC, and in a few weeks, the courts will be ready to embrace the competition all over again...

I can't help but think that the players will have gone through somewhat the same process.

Two weeks ago, dreams showed up pristine. No longer. Most have gone to the airport and are now winging their way en route to the next tournament in hope that the next court will be more kind.

How tough has it been?

The phone calls and texts tell the story.

'I know it hurts, but at least you played in the granddaddy of them all.'

'Maybe next year.'

'That was a rotten call. If only...'

'Just know that one of these days, you will be able to tell your kids and grandkids that you played in Wimbledon.'

'Did you get to see Kate Middleton? I can't believe that you were there.'

It's like there is a team of wordsmiths waiting to repair the damage of an early exit.

To be sure, the kind words help. But the real therapy will take time. Maybe it will come with a future win or another dream brought on by years of optimism drummed into the players, family and coaches. But just maybe, age will do the trick, not by winning in another year but just knowing that even in losing, they won as they played on the grass courts of history.

It is simply an amazing experience to watch the drama unfold. From courtside to the training table, seemingly every emotion has been on display. There just is not anything like it. Wimbledon. On grass. It's just about a wrap."

Live from Wimbledon -- Clay Sniteman, PT/ATC for the Tennis Professional Circuit.