Nick, Our Thoughts

Achilles tendon injuries are very commonly associated with sport and exercise, can often take a long time to heal, and often recur when returning back to sport and exercise – very frustrating!

The good news is that most Achilles tendon injuries respond well to conservative management consisting of an initial period of rest, Physiotherapy treatment, a programme of stretches and strengthening exercises, and a graduated return to sport and exercise.

With the above in mind, here is an example of how an Achilles tendon injury can respond very well to conservative management;

Recently a patient came to see me regarding a stiff and sore Achilles tendon that had been troubling her for about three months. She injured her Achilles tendon when she slipped on the muddy ground while going for her regular lunchtime walk around Auckland Domain. She initially rested her Achilles tendon for a few weeks and when it felt better, she tried to go for a lunchtime walk in the Domain, but her Achilles tendon quickly became stiff and sore again. This pattern continued over the next few months, i.e. a period of rest, her Achilles tendon feeling better, and then the pain and stiffness returning as soon as she tried to exercise again.

When I first saw her at Olympic Physiotherapy I assessed her injured Achilles tendon and saw that it looked puffy, was tender to touch, and her calf muscle above the injured tendon was weak and tight. Treatment consisted of massaging her injured Achilles tendon with anti-inflammatory cream, stretching her tight calf, and icing her Achilles tendon. I also encouraged her to do this at home twice daily and to start some light stationary cycling on a daily basis. After a week she reported her Achilles tendon was feeling a little better, and after two weeks she was very pleased to report her Achilles tendon was feeling much better!

 I have now suggested she go for a short lunchtime walk in the Domain every second day, exercycle lightly on the days in between, and to continue with the massage, stretching and icing in the evenings. I have also started her on some light strengthening exercises which will further assist her recovery, and help reduce the chances of injuring her Achilles tendon again in the future.

I hope the above example reassures those of you that are suffering from a sore Achilles tendon, or have suffered from an injured Achilles tendon in the past, that most Achilles tendon injuries recover very well if managed correctly.

With the above in mind, give us a call here at Olympic Physiotherapy if you are suffering from a stiff or sore Achilles tendon, as we would be very happy to assist you with your recovery and a successful return to your regular sport and exercise!

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Health
Did you know that people who suffer from periodontal disease (gum disease) have a higher risk of
strokes and coronary artery disease? Gum disease is often triggered by plaque overload!

Oral plaque does affect the heart. This is why proper oral care, which minimizes the presence of
plaque, is so vital to staying healthy over the long term. Today, we are going to share more information
about the connection between plaque and the heart, as well as oral health care tips which will help
you to reduce the risk of stroke and coronary heart disease.

There are two possible reasons why plaque is linked with the risk of heart issues. One possible
reason is that the germs which trigger gum disease put toxins into the bloodstream and these toxins
contribute to the formation of fatty plaques within the arteries. Deposits made from plaque may trigger
serious issues such as blood clots. Blood clots negatively impact blood flow.

The second possible reason is that bacteria provoke the liver organ to produce proteins in higher-
than-average amounts. These proteins cause inflammation in the blood vessels. This may set the
stage for a stroke or a heart attack.

Do You Have Periodontal Disease?
When tartar and plaque aren’t removed, they become harmful. If you suspect that you may suffer
from periodontal disease, you should schedule an appointment with a local dentist.

Dr. Johay Amith from Dental Today says, “If you don’t have dental coverage, look for community
services. Some dentists will charge on a sliding scale based on income, in order to help those in need
by making the cost of dental care more affordable”.

If you see signs including chronic bad breath, gums which move away from teeth, a bad taste in the
mouth, gums which are reddened, tender and swollen and separation or loosening of permanent
teeth, it may be an indicator that periodontal disease may be negatively impacting your oral health. If
you find that your teeth seem to fit together differently when you bite down, periodontal disease may
be the reason why.

In addition, if your dentures don’t fit properly (as they used to), you will benefit from visiting a dentist
and finding out if gum disease is changing the way that your dentures fit. Gum disease is often
triggered by too much plaque so, it’s important to try and reverse periodontal disease as soon as it
strikes. It’s never too late to see a dentist. A lot can be done to improve oral health, whether you are
experiencing gum disease or another oral health issue.

Dental plaque contains bacteria. To combat the growth of plaque, get your teeth cleaned by a dentist
every six months and brush and floss twenty minutes after every meal. Other forms of dental care
may be needed. However, only a licensed dentist will be able to recommend the right processes. This
is why regular dental examinations and cleanings are so important.

Take Good Care of Your Teeth
There is a lot you can do in order to minimize the presence of plaque. Aside from brushing and
flossing regularly and seeing your dentist for check-ups and cleanings, you may want to avoid sugary
foods and acidic foods. Both negatively impact oral health. Consider supplements which are proven
to improve oral health. Examples include probiotics and fish oil. Lastly, eating an apple a day will be a
great way to clean your teeth when no toothbrush is handy.

Now that you know how plaque affects the heart, why not improve your oral care routine today and
book an appointment with your dentist?

Authors Bio:
Robert Hudson is studying a bachelor of Communications and majoring in journalism. He has a
passion for health and comes from a family of dentists. For the last 6 years, he has lived in New
Zealand and is determined to continue living in this beautiful country. If you have any questions or
would like to connect with Robert please message via Google
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Nick, Stu

Tips for Preventing Foot and Ankle Injuries

Foot and ankle injuries are common in sports, especially in winter sports such as rugby, netball, and soccer. But you can reduce the risk of injury by taking some simple precautions.

Use strapping or a brace if you have sprained your ankle before

If you have sprained an ankle before, getting your ankle strapped (or wearing an ankle brace), will greatly reduce your chances of re-spraining your ankle. This is particularly important if your previous ankle sprain was recent.

Warm up prior to training and playing

Get to training and games early so you have time to do a thorough warm-up. If you are well warmed up you are less likely to get injured. Warming up is particularly important when it is wet and cold through the middle of winter. ACC’s SportSmart website (https://accsportsmart.co.nz/warmup/), has some excellent warm-up routines specific for rugby, netball, league and touch rugby.

Condition your ankles for your sport

Doing some drills at training that are specific for your sport to improve your balance and strength will help reduce the chances of foot and ankle sprains. An example of one of these drills would be regularly balancing on one leg with your eyes closed for 30 – 60 seconds to improve balance. At Olympic Physiotherapy we can design a specific programme of exercises to help you improve your balance and strength specifically for your sport. Netballers may like to visit Netball New Zealand’s website (http://netballnz.co.nz/useful-info/netball-smart), which contains some excellent drills and training advice with regards to injury prevention.

 Choose shoes that are specifically for your sport

Wearing shoes that are designed for the specific demands of your sport is very important. Cross trainers are an overall good choice, however, it is best to use shoes designed for your sport. Nike Free Runners are not sports shoes!

Replace your shoes regularly

You should have started each season with a new pair of shoes, and replace them during the season if they show signs of wear and tear.

Listen to your body

If you experience foot and ankle pain at training or during a game, stop until the pain subsides. If the pain persists, you should ice the painful area and make an appointment at Olympic Physiotherapy for assessment of your injury and appropriate treatment before returning to your sport.

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Stu
Whether you’re a competitive athlete, weekend warrior or just enjoy walking the dog, good physical fitness is important to most of us. Injuries can be frustrating particularly when we have worked hard towards reaching our goals; whether it be tramping to Everest base camp, running a half marathon or keeping up with your kids activities. Some knowledge about our own body can go a long way towards helping us to perform better whatever the activity. This is where a Muscle Balance Assessment (MBA) can assist, particularly if you are tired of those repetitive strains and niggles that continue to hold you back. The MBA is a one hour long appointment and takes your history of previous injuries into account in conjunction with an in depth analysis of: – Muscle length/tightness and strength or weakness in key areas. – Poor movement strategies – Poor technique in sports specific areas These results are illustrated in a report format and exercises to remedy any adverse findings will be taught at a follow up appointment. We are happy to liaise with Personal Trainers, Coaches, Pilates Instructors, Doctors and the like, to ensure a team approach with you being the number one focus! “The idea is to provide you with an effective group of exercises designed to complement your current program or just simply as a preventative regime.” The MBA is also an excellent idea for adolescent athletes who are striving to make the jump from school sports to more competitive senior levels. The aim is to identify potential issues before they become a problem and to ultimately assist and improve overall performance.
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Stu
This is one of the most common conditions I see as a sports physiotherapist in my clinic. Patients generally describe a deep ache in the front of the knee. It is often felt ‘underneath’ the patella (kneecap). The pain is generally worse with activity which requires repeated knee flexion. Activities which make the pain worse include walking up or down stairs or hills, squatting and sitting for prolonged periods with the knee bent. The good news for people with this type of pain is that it generally does not mean that there is a structural problem with the knee. The pain is generally precipitated by a change in activity level as well as a number of biomechanical predisposing factors. Athletes with this type of pain may have tight muscles, be relatively weak or have anatomical problems – for example pes planus (flat feet). The pain generally improves or resolves when these are addressed.  The following program is a good starting point to treat this problem. It can be personalised to your exact needs if you are not seeing the improvement you would like.

Exercycle Program I feel, and research agrees, that this the single most important part of the rehabilitation program for patellofemoral pain. The idea is to set the bike up so the saddle is a little higher than you would normally like. This limits the amount of knee flexion you are working with. Aim to spin on the bike at a very low resistance (easy) and high cadence (aim of 80-90 revolutions per minute) for 30 minutes. Think ‘polishing the knee’ rather that getting a big cardiovascular workout. Try to do this everyday if possible.  You can increase the resistance as you get comfortable with this.  Keep the resistance constant rather than doing repeated intervals of higher intensities.

Muncie (Quads) Exercise This exercise was developed specifically for the rehabilitation of patellofemoral symptoms. Sit on the floor and flex the unaffected knee until the heel of the foot is in line with the painful knee. Lean forward and hug your good knee. Keeping the painful knee extended pull your ankle back towards you and turn your foot out to either 2 or 10 o’clock (depending on whether you are working on your right or left knees). Lift the heel up off the ground and hold for 5 seconds. Repeat this 20 times per day. To make the exercise easier pull the heel closer to your butt. To make it harder slide the heel away from your butt. Be sure and stay leaning forward. If you can’t find a place on the floor to do these then just sit on the edge of your chair with the affected leg out straight in front of you and repeat the above. There is no need to hug the knee in this position but you are able to lean slightly forward as above.

Gluteal (Butt) Exercise Lie on your side fully stretched out. You should lie on the opposite side of the hip you are trying to strengthen. Flex the top hip and knee until your foot is resting on the lower knee. Lean forwards onto your top arm. You should be in the position shown below. From this point slide the top knee a few centimetres away from you. Lift this knee 5cm off the ground and hold this for 5 seconds. I tell my patients to try and join ‘the 100 club’… i.e. to do 5 sets of 20 reps through a day! As with all problems it is important to have an accurate diagnosis to make sure that the rehabilitation is going to be successful.

If you are unsure about your diagnosis or are not getting better as quickly as you would like, make sure you book yourself in to see a physiotherapist or sports doctor. You can find me at my clinic The Body Refinery in Newmarket, or our new location in St Heliers, Auckland.
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Stu

platesHow Meditation and Mindfulness Can Help

Plate spinning is a circus manipulation art where a person spins plates, bowls and other flat objects on poles, without them falling off. Plate spinning relies on the gyroscopic effect, in the same way a top stays upright while spinning. The actual art of plate spinning is not too dissimilar to what many of us try to do in everyday life. Stay upright while running to and from meetings; focusing on multiple goals; KPI’s; more meetings; remembering to have lunch; looking after staff; remembering to respond to that email from 3 weeks ago; booking the insurance for that holiday in 2 months time… And the list goes on! In the beginning, spinning plates can be fun, give us variety in our day, and can be quite rewarding as we manage to pull off achieving multiple goals in a day or a week. But after a while some things are forgotten, unfinished and become stressors in our already busy lives. To add to this forever growing to-do list, we have our smartphone constantly in our pocket, vibrating, ringing and reminding us of how many plates we actually have up in the air at one time. We have got into the habit of constantly checking our phones for new emails, Facebook status updates, Twitter feed, missed message and calls. Once upon a time we would leave work and begin to switch off. That phone from back in late 90’s and early 2000’s didn’t have data or a screen that could read more than 1-2 lines of text for that matter. By the time we reached home we would be ready to change down another gear, chat with family, sit down and watch a favourite TV programme, read a book. Ultimately, we would log out, switch off and unwind from the day we had just finished. What if we could use this technology we have now, to take time out of our day to switch off for very small periods of time and reset our minds? All of a sudden some of the plates we thought were important would vanish. Our minds would become more focused. Stress levels would decrease. Things would become clear and simple. Real focus and clarity would begin to creep in and we would all look much less like a circus act trying to spin a whole lot of unbalanced plates in mid-air while running down the road! I have been doing yoga for about 18 months now. It gives me both physical benefit from the stretching and strengthening of muscles, and the mental benefit of clearing my mind from the day-to-day clutter it accumulates. But I wouldn’t have time most days to do a class in the middle of the day, even though this is when I would benefit most. So recently, my very mindful, present and yogic partner put me onto the idea of downloading a meditation app for my smartphone. So I did! Since then I have been endeavoring to use the app at least once a day for 10 mins. I find it’s great for removing all those redundant thoughts and stressors which simply get in the way of me achieving what is important to me in my day. The app I am using at the moment is Headspace which has various guided meditations to suit you. So, my advice to you: click on the app store, search for ‘Headspace’, download, put your earphones in and press play! It’s only 5-10 mins out of your day, and the change that it can bring is absolutely incredible. Just do it!

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Anna
A high performing team can be defined as “a group of people with specific roles and complementary talents and skills, aligned with and committed to a common purpose, who consistently show high levels of collaboration and innovation that produce superior results.” Coming up with the definition of a high performing team is relatively easy, it is the development of a team that meets this definition that is the hard part. By taking what I have learnt from high performing professional sport and applying this to various corporate environments, I have found the following as fundamental to the development of a high performing team: 1) Very clear, visible and shared objectives that are linked across all members of the team, including the manager. These objectives should be defined as either high performing measures or general measures. The general measures are the ‘ticket to the game’; basically a measure of doing the role, whereas the high performing measures are what defines success in that role. Examples could be: • General measure: consistently completing 80 per cent or more of training programme each week (sport), completing all invoices on time (business) • Performance measure: achieving podium performance in every race of the season (sport), growing customer base by x per cent within the financial year (business) It is important to share these objectives within the team. This ensures everyone is working toward, and supporting each other, in achieving a common goal. 2) A documented development plan for each person in your team. Often development discussions are very abstract, usually starting with the question ‘where do you see yourself in 5 years’ time’. Although this might be a good question to start some thinking, it isn’t going to help that person reach their goals unless they are aware of what skills they need and how to go about developing them. Using a ‘development triangle’ has been useful for the teams I work with. The base of the triangle is the current role and/or skillset with the top of the triangle being the long term goal. In the middle are the next step roles and/or skillsets required to reach that goal. This should be reviewed at least twice a year to ensure relevance and active development of skills required. Ask any top level athlete and they will know exactly what their objectives are, and the required skills needed to reach them. When these objectives are shared in the team and everyone supports the individual development of each team member, an environment is created that will ensure high performance.
Three years ago, while working full-time, Anna left the corporate world to pursue her dream of becoming a professional athlete, competing around the world in Ironman triathlons. Anna now writes about her experience as a professional athlete and how her learnings can be applied to drive high performance in both individuals and teams. For further information visit: www.annarusselltriathlete.co.nz/anna-russell/
 
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Stu


Do you ever wake up in the morning to your alarm blaring? You get an initial fright, press snooze, drift in and out of sleep with thoughts of your to-do list for the day coming at you like trucks on a busy highway? Or are you awake 15 minutes before your alarm in anticipation of the day ahead and thinking back to those same ominous trucks from the day before that you didn’t manage to clear from you ‘brain highway’?


Brain highway. That’s what I like to call our conscious/ unconscious thought process. The hundreds, if not thousands of thoughts that pass through our heads everyday. Research shows that we actually have 2500-3300 thoughts every hour! Most of these thoughts pass through fleetingly and move on into the background. But some tend to stick around for a bit running tight circles in our head with their foot on the accelerator and blaring their horn, like a big scary truck! Just picture that. A big scary truck doing tight circles around you while blaring its horn at you! You can do nothing but notice it. In fact you are more than noticing it at this stage, the truck is huge in your field of vision and blocks everything else out. All you can do is concentrate on this one seemingly horrible, scary thing in front of you! Everything else that you were doing a few seconds ago is completely blocked out and your body starts getting into fight or flight mode. Your stress hormone cortisol starts to rise. You start to sweat and get anxious.


What if I told you that you could take control of this situation. You could get that nasty truck back on the highway with the other trucks and cars and off into the distance. As a physiotherapist I teach people every day how to perform exercises to strengthen a muscle or tendon in their body. They go away, do the exercise for a specific amount per day and week then come back with less pain and more strength. We can apply the same model to our brain and thoughts. The brain is the muscle and the stressful thoughts being the injury or niggle.


I was going through a particularly stressful time with my business at the same time. Thoughts were rife, my highway was the size of a Los Angeles freeway. The five-lane variety! Because my mind was so busy with trying to wear the many hats of a business owner working on and in my own business, I couldn’t decipher, allocate and file each task in its order of importance. I would get anxious, worried, angry, frustrated, down and tired trying to do it all!


This thought process and a little nudging from my partner got me started on a little app called Headspace. I made a conscious decision to take control of my thoughts, to give my head a little… space! I’m great at getting to sleep at night. I’m asleep within about 10 breaths of the light going out. It’s 4.30/5am that my mind decides to wake up with a jolt. Thoughts, concerns, stories left over from the day before. Scenarios played out in my head, which have not even happened yet. Numbers, figures, reports, forecasts… you get the drift. So this was my plan. I would start meditating 5 minutes after my alarm went off every morning. Just 10 minutes of headspace. I started with the intro pack, a nice way to dip my toes into the world of meditation. Two sessions in and no epiphany, no higher level of consciousness. I thought, this meditation thing doesn’t work, it’s a hoax! But a little voice inside me kept saying, just another session, keep it up. So I did. Five sessions in and I was still doubting. But on returning from work one day after maybe my tenth session my partner asked me how my day was? A very normal question which a few weeks previously would have got my heckles up, got me all frustrated with a short answer in tow. Not this time though. ‘It was good thanks, it was very productive, clear and I had lots of fun’ was my reply! Such a contrast from my previous mindset. Life was good again even though I was still dealing with the afore-mentioned stressor. I had clarity of thought and was less distracted, which led me to be much more productive in my day.


A few months later with the acute stress over I managed to meditate 100 days in a row. Pretty awesome for a guy who had no idea what meditation meant a few months prior.


Moral of the story: “Meditation” the art of calming and focusing the mind, give it a go! What’s the worst that could happen? 

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Tania

I recently returned from Bali. It was so luxurious. So indulgent. I got massages. I didn’t have to make my bed. All my food was cooked for me. I didn’t have to do dishes. I woke early every morning to meditate and do a two-hour yoga practice. I withdrew into silence for 24 hours. I was driven around in golf carts. I stared deep into the jungle. I climbed a volcano. I swam. I surrounded myself with lush greenness.

By the time I got back to New Zealand, aside from feeling a little jet lagged, I felt amazing. All that talk about making sure your cup is full? Well, mine was positively overflowing. 

However, timing meant that my dad went in for his knee reconstruction while I was away. I badly wanted to be here for it, but it wasn’t to be. My brother came out from Australia with his four-year-old to help Mum out. When I arrived back, Dad was still in the hospital. His knee was healing well and he came home the following day. My partner, Stu came north to join us. 

I stayed at my parents’ house for four days. I helped Dad up and down from his bed and chair. I helped mum cook meals. I helped Dad do the exercises from the physio. I helped my nephew build Lego. I reminded Dad to take his medication. I helped my brother with chores around the house. I did my best to make sure Dad didn’t feel like a burden. I made sure that Stu was okay, as he had his own life stress going on. By the end of the four days, I was a wreck. I was exhausted. Said cup was now back to empty. And it was time to return to work. 

By Friday I was starting to return to normal. On Saturday I headed back to my parent’s house and this visit included six hours in ED one night.

By now I was starting to get a really good picture of what self-care meant to me. And also what it meant, and how I felt, without it. 

So I went to a heated yin class. I took a bath. I went for a walk with a good friend. I sat on the couch and did not much. I surrounded myself with lush, green nature. I turned up the music and sang while I drove. I went for brunch with a good friend. I read. I listened to podcasts. 

And after all of this, my cup started to feel full again. I felt like I could show up and be my best self for my partner, for my Dad, for work. I sometimes find the language of self-care doesn’t sit quite right with me. But the last few weeks have shown me that regardless of what I call it, I need to make sure I prioritise time for things that make me feel whole. 

So what do you do for self-care? How do you make sure that your cup is full? Or, if you’ve never thought about it, maybe today’s the day to take five deep breaths, just for you.

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Stu
Gait is the way in which we move our whole body from A to B. Most often this is done by walking and running. Gait analysis is used to assess the way we walk or run to highlight biomechanic abnormalities, and then how to correct these.

What are Biomechanic Abnormalities?
Being able to move in an efficient way is important in reducing the risk of injuries. Having joints allowing sufficient movement and muscles able to provide sufficient force is essential to generate an efficient gait cycle. If joints are stiff and/or muscles are weak, the body must find ways of compensating for the problem, leading to these biomechanical abnormalities.

Some examples of these abnormalities are:
– Pronation
– Supination
– Increased Q angle
– Hip hiking (or hitching) (lifting the hip on one side)
– Ankle equinus (limited ankle dorsiflexion)
– Pelvic tilt (can be either anterior, posterior or lateral)
– Trendelenberg gait

These biomechanical problems are usually caused by muscle imbalances. Sometimes they can be caused by structural problems, such as leg length discrepancies resulting in hip hitching.

What is Gait Analysis?
Gait analysis is usually performed by a professional such as a Physiotherapist or Podiatrist. Gait analysis usually involves walking or running on a treadmill. In some cases, the professional will simply watch the way that you move, looking in particular at your feet, ankles, knees, hips, pelvis and lower back. In more specialist settings, a video recorder will often be set-up behind, to the side and in front of a treadmill. This can then be relayed to a laptop where slow motion and freeze frames can be used to carefully assess your running or walking style. Most injuries are often caused by poor biomechanics. Runners and athletes whose sports require a high level and/or distance of running should make sure they have had a gait analysis and buy the correct footwear to avoid future overuse injuries.

The following are a list of common overuse injuries associated with poor gait biomechanics:
– Shin splints
– Plantarfascitis
– ITBFS (iliotibial band friction syndrome)
– Patella tendonitis
– Patello-femoral dysfunction
– Achilles tendonitis/ tendonopathy
– Lumbar or low back pain
– Hip bursitis

The Gait Cycle in Walking and Running
The gait cycle is the continuous repetitive pattern of walking or running. The gait cycle is split into two main phases, stance and swing phase, with one complete gait cycle including both a stance and swing phase. The stance phase is the period where the foot is in contact with the ground. The swing phase is when the foot is not on the ground, i.e. in the air.

– Stance Foot Strike: the point when the foot hits the ground
– Midstance: where we are transferring weight from the back  to the front of our feet
– Toe Off: pushing off with the toes to propel us forwards
– Swing Acceleration: the period from toe off to maximum knee flexion in order for the foot to clear the ground
– Mid-swing: the period between maximum knee flexion and the forward movement of the tibia (shin bone) to a vertical position
– Deceleration: the end of the swing phase before heel strike When running, a higher proportion of the cycle is swing phase as the foot is in contact with the ground for a shorter period.

Corrections to your Gait Cycle
If it is found that there is an abnormality of your gait cycle. This can usually be correct with reviewing your footwear, and the implementation of a muscle balancing (strength) program. Specific running shoes can aid those who over-pronate, over-supinate or have a neutral position.

It is important to make sure you have the right running shoes for your style of running. Implementing running drills are important to help break down the running gait cycle into parts. This allows the client (person learning to improve their gait) to work on perfecting each part of the cycle, which in time will improve their running form.

This allows for improved running efficiency, reduced risk of injury, and ultimately creates a faster and better-looking runner.
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