Is a running gait assessment worth your time and dime?
For as long as I can remember I have enjoyed running; to the stop sign, around the track, and eventually 50k through the Headlands. Naturally as a physical therapist I have been curious about how to run more efficiently, smoothly, and of course, faster. Luckily I married a PhD in Exercise Physiology, so conversations about biomechanics and running performance are common-place in our household.
Recently, one of his friends—a semi-pro runner who logs 60–70 miles a week—went to a running clinic for an evaluation. The session included strength testing, “foot mechanics” assessments, and gait analysis using high-tech cameras, biomarkers, and an experienced clinician. Afterward, he came home deflated, explaining he was told he “overstrides,” has a “crossover gait,” and “too much vertical oscillation,” among other faults.
My husband immediately launched into a critique of this running program. He pointed out that a narrow step width—something this clinic flagged—is actually common among elite runners because it’s more economical for energy expenditure (think: less air resistance). He proceeded to do a deep dive on the research and proved his point. While narrow step width may improve efficiency, it can also increase lateral biomechanical forces—something I often see contributing to issues like ITB-related pain. Interestingly we come at this from two different lenses: the performance (his) and rehabilitation (mine) perspectives and technically we are both right.
Our bodies are smart, resilient, and inherently programmed to move efficiently to conserve energy. Adaptations naturally emerge to meet the demands we place on ourselves. Problems usually arise when those demands exceed our body’s capacity.
So, when someone comes to me with a running-related injury, yes—I put them on the treadmill to assess their gait. Why? Because there are biomechanical changes we can make to redistribute force and reduce strain on overstressed tissues. If someone is overstriding, their tibia and knee are absorbing more impact than if they were landing midfoot. The ground reaction force remains constant—your body weighs the same with every step—but we can adjust where that force is absorbed.
For example, modifying foot strike can temporarily offload irritated tissues. But it’s not without cost: changing a long-established pattern can increase metabolic demand and shift stress to unfamiliar tissues. For a semi-pro runner, the timing of this adjustment is everything. Two weeks before a race? Not ideal. Four months out? Much better.
Ultimately, research shows that most people revert back to their natural running gait despite cues given from the well-meaning clinician. With years and miles of training this may change, but if a change is imposed too quickly there is a cost: both metabolically and on the tissues that are now experiencing more work.
TLDR: There is no “perfect” way to run. Strength and consistency are what truly increase your body’s resiliency to withstand the significant demands of running.
