Should Runners Get Running Gait Analysis?

My patient who's training for a marathon came to me this past week telling me she had a friend who had just gone for a paid running gait analysis. Stride length, cadence, gait symmetry were all filmed after checking for muscle imbalance, flexibility and joint alignment. She was tempted to go too.

I shared with my patient a really interesting article I read this past week (Cochrum et al, 2021). The study assessed if running coaches could visually assess a long distance runner's running economy. These 121 running coaches were coaching high school runners to runners at international level.

Running economy was measured in 5 trained recreational runners at about 12.8 km/ hour. The runners were filmed from the front, side and rear while running on a treadmill. There was a minimum VO2 difference of 2 mL.kg/ min between adjacent runners that the coaches visually assessed.

The coaches viewed each video and ranked the runners on a scale from 1 (most economical) to 5 (least economical). They also completed a demographic questionnaire and listed running style biomechanical observations they used in determining each ranking. 

There was also a statistical algorithm to determine the effect of coaching level, years of coaching, training experience, competition level, certification status and educational level on the ability to accurately rank running economy.

Get ready for this, NONE of the coaches ranked them all correctly. Only 6 percent (or 7 out of 121 coaches) managed to identify 3 correctly.

In our clinics, we sometimes blame running economy (due to cadence, stride length, running style, gait) as a cause of problems or injuries. From the research paper, it is surprisingly difficult to judge visually.

Perhaps most runners do not have a "wrong" running style or form. Running mechanics are definitely self organized. As one trains more regularly, their body would gradually find the path of least resistance. The running style would then suit their anatomy and training load after accounting for their injury history, and strength. 

Much research suggests that runners often become more economical simply by running regularly, without needing to consciously change their running style and technique (Van Hooren et al, 2024)

Does this mean most runners do not need running gait correction? Since biomechanical measures did not reliably predict injury suggesting that we cannot so easily "see a risky/ wrong running gait" and fix it. 

Most healthcare professionals may disagree (since it means they cannot charge their patients more) and I would encourage you to pause and take a step back. Do not assume your running style is the problem however fancy these "advance" running gait analyses may promise. Especially if you are not injured.

I am also not saying running gait analysis is useless. It can be helpful when a runner is already injured. Small adjustments like shortening stride length, width or increasing cadence can easily help runners with knee pain and help them return to running more comfortably while the underlying tissue settles.

So, if you are a healthy, non injured runner looking to run faster or even prevent injuries, it's better to work on your strength, recovery, consistency, training load and progression. Your running style may not need correction. Your body would have already figured that out, especially if you are a serious runner with more than 5 years of consistent running.

I may look at and discuss running gait in our clinic as part of my assessment, but it is usually not a immediate area of concern. Personally I do not like looking at running gait on a treadmill since it will be different compared to running outside. I would get my patients to run outside while watching them if I need to.

Unfortunately there are many other healthcare professionals who do not understand this or choose not to understand (so they can make more money), to keep up with this misconception.

References

Cochrum RG, Conners RT, Caputo JL eyt al (2021). Visual Classification Of Running Economy By Distance Running Coaches. Eur J Sp Sci. 21(8): 1111-1118. DOI: 10.1080/17461391.2020.1824020

Van Hooren B, Jukic I, Cox M et L (2025). The Relationship Between Running Biomechanics And Running Economy: A Systematic Review And Meta-Analysis Of Observational Studies. Soorts Med. 54(5): 1269-1316. DOI: 10.1007/s40279-024-01997-3

Running Associated With Good Intervertebral Discs Adaptations

Remember how I previously wrote that running helped eased my back pain after my compression fracture following my first bike accident. Well, this is not just coming from me (n=1) who has 2 compression fractures in my spine. A recently published article this past week (on 5th March 26) shows that running is associated with good intervertebral disc (IVD) adaptations (Samanna et al, 2026) too and thus may help those suffering from chronic low back pain.

The authors, in their randomized controlled trial, showed  how a 12 week run-walk program affected the spinal health of 40 adults with chronic low back pain.

The subjects either followed a digitally delivered progressive run-walk interval program of doing 3 run-walk days each week at 30 minutes a session or in a waitlist control group.

 

MRI were used to track changes in the health of the T11/12 to L5/S1 IVD relaxation times. This is a reliable way to assess IVD hydration and structural integrity. This was done at the start, 6th and end of the 12th week of the run-walk program. T2 values were tracked since it is influenced by IVD composition and water content, with higher values indicating higher hydration and better IVD health.

The results surprisingly showed that the subjects with more significant multi level IVD degeneration actually showed more favorable improvements in the IVD health after 12 weeks. Even more improvement than those with healthier discs.

This suggests that even IVD's that have already undergone degenerative changes still have the capacity to adapt and rehydrate when exposed to regular, dynamic movement. The "degenerated" IVD's with lower baseline hydration may also show greater potential for rehydration and measurable improvement since they are starting at a lower base.

A person's body mass index (BMI) did not significantly change how they responded to the program.

The study showed that a total running volume between 28.6 to 46.1 km over the 12 weeks led to best results for the IVD T2 changes. That is a manageable weekly average of 2.4 to 3.8 km.

Moderate running speeds between 10.5 km/h and 11.7 km/h was associated with better outcomes at the 12 week mark. 

Running on grass was also identified as a positive factor for improving disc health. Possibly because of a lower biomechanical load compared to running on concrete.

There was also some negative effects briefly seen at the 6 week mark with lower running speeds or those with mild degeneration, but they disappeared by week 12. This implies that the initial weeks may involve a temporary "adjustment" phase as the body adapts to new movements from a new exercise. Sticking with the program leads to long term benefits.

Do note that the sample size is fairly small and an improvement in T2 values may not necessarily reflect physiological or therapeutic improvement. The subject has to feel less back pain. I definitely have less back pain after running. Your discs definitely need the gentle loading from running.

Reference

 

Samanna CL, Neason C, Tagliaferri SD et al (2026). Running Is Associated With Intevertebral Disc Adaptations : A Pre-Planned Secondary Analysis Of The ASTEROID Randomised Controlled Trial. Eur Spine J. Epub 5 Mar. DOI: 10.1007/s00586-026-09759-7.

Inflammaging Across Human Populations

Aging is more than just getting gray hair and wrinkles. It is a gradual decline in how our cells in the human body function.  This can result from various metabolic, environmental and genetic factors. When our cells accumulate damage, important systemic processes in our body become dysregulated, and this leads to an increased rate of disease and mortality.

Inflammaging, a combination of inflammation and aging is when there is a chronic, low grade persistent  inflammation occurring in the body without infection or obvious injury. 

This is characterized by increased levels of inflammatory markers in the blood. The term was first coined by Claudio Franceschi to detect the systemic, hard to detect inflammation that creeps in with advancing age.

Inflammaging stems from an immune system that is malfunctioning, when there is overstimulation of our natural immune system and when damaged cells there do not die (cellular senescence). 

Increased tummy fat, genetic predisposition, accumulated cell damage and lifestyle factors like chronic stress and poor diet can contribute to it. It is a sterile and persistent process not triggered by acute infection. It accelerates aging and contributes to age-related diseases like Alzheimer's, diabetes, arthritis and cardiovascular diseases.

It then leads to functional decline, frailty and increased mortality.

A study published recently suggested that low grade chronic inflammation may be actually tied to environmental factors in industrialized countries. This suggests that inflammaging may not be equal in different parts of the world.

The researchers analyzed data from 4 different populations. Italy and Singapore (industrialized) and 2 non-industrialized (indigenous communities) in the Bolivian Amazon and Malaysia (Orang Asli). 

Orang Asli

They found that inflammation levels increased with age in industrialized societies while this was absent in the non-industrialized societies studied. In the non-industrialized societies, inflammation appeared mostly linked to short term infections rather than chronic age-related diseases.

Their findings suggest that the persistent inflammation seen in wealthier nations may be more influenced by lifestyle and environmental factors such as pollution, diet, levels of physical activity rather than aging itself. 

This shows the need to consider both environmental and cultural contexts while studying the causes of aging. 

The human species have gone from increasing lifespan over the past 150 years to extending lifespan and living well. 

Before falling from grace recently because of ties with Jeffrey Epstein, Peter Attia and American entrepreneur Brian Johnson have been at the forefront of the "living forever" (or longevity) movement. Johnson has even organized the Rejuvenation Olympics to get participants to find ways including exercise and dietary supplements to slow biological aging. 

Johnson's tactics have been labeled extreme in cost and nature especially when he gets regular injections of blood from his teenage son. Perhaps he needs to go live in indigenous communities for a while to help him in his quest.

Reference

Franck M, Tanner KT, Tennyson RL et al (2025). Nonuniversality Of Inflammaging Across Human Populations. Nat Aging.5 : 1471-1480. DOI: 10.1038/s43587-025-00888-0