About this episode
This episode of the Root Cause Medicine Podcast explores the Modern Running Assessment, an evidence-informed, data-driven framework for evaluating runners’ biomechanics, load tolerance, and performance capacity. Host Dr. Kate Kresge interviews Dr. Chris Sands, DPT, OCS, and Dr. Gabe Kresge, DPT, from Kinetic Physical Therapy to examine how modern tools—dynamometry, force plate testing, slow-motion gait analysis, cadence and vertical oscillation metrics, and single-leg endurance testing—provide objective information that visual observation alone may miss. These measurable insights help clinicians better understand strength-to-body-weight ratios, inter-limb asymmetries, foot-strike loading patterns, and fatigue-related movement changes, offering a clearer picture of the factors that may influence running efficiency, durability, and injury risk. Clinical Takeaways: Evidence-Informed Running Biomechanics and Performance Metrics Dynamometry can quantify strength and help to reveal relevant asymmetries. Consider dynamometry for hip and knee strength assessment to reveal inter-limb asymmetries that can affect gait and joint load. Limb asymmetries should be interpreted within a broader biomechanical context. Inter-limb differences are common, and evidence for their direct impact is mixed. Reviews indicate that asymmetry effects vary across athletes and may be most useful when tracked over time rather than interpreted as a single cutoff. This conversation focuses on asymmetric joint loading during runs, which can increase with distance and fatigue (Li, 2025). Gait analysis is still relevant. High-speed and slow motion video helps clinicians evaluate variables such as vertical oscillation, cadence, pelvic motion, and trunk rotation—mechanics that may support targeted interventions. Optimal foot strike patterns can shift depending on a runner’s goals. Reviews show that foot strike patterns redistribute forces differently across joints but do not consistently prevent injury (Altman 2015). Pronation is a normal shock-absorption mechanism, and comfort is a meaningful predictor for footwear selection. Progressive strength training supports running economy and performance. Strength programs integrated with endurance training support improvements in running economy (Rønnestad 2014, Llanos-Lagos 2024) and performance (Prieto-Gonzalez, 2022). There is no perfect running shoe. Thousands of studies have helped us understand all of the variables that go into shoe choice, from stack height to lace patterns, heel flares and heel-toe drop, bending stiffness, heel cup and more. The short answer: there’s no perfect shoe. Runners should work with professionals to help them choose the shoes with the right combinations of features for their mileage, pace, goals and physiology. (Sun, 2020) Implement periodic reassessment to refine training and monitor adaptation. Regular reassessment of strength, asymmetry, and gait metrics supports adaptive programming and individualized progression. Timestamps : 00:00 – Welcome back and introduction to the Modern Running Assessment 03:52 – Setting goals first: performance vs. pain and how that shapes the assessment 05:47 – Dynamometry explained: measuring force, 2–4x bodyweight load, and asymmetry 11:53 – Strength vs. endurance: calf fatigue, single-leg control, and why bilateral lifts don’t always translate 18:13 – Force plate testing, vertical oscillation, and how cadence tweaks can reduce impact 26:58 – Born to Run, barefoot trends, foot strike, and what really changes with minimalist running 30:38 – Shoes, pronation, anti-pronation models, and when added support actually makes sense 34:24 – Trunk and thoracic mobility: how chest position affects breathing, heart rate, and endurance 37:46 – Foundational strength for runners: split squats, single-leg RDLs, lateral work, and deficit calf raises 41:09 – Will strength training make you “too bulky”? What the research says about muscle, speed, and long-term joint health, plus shoe rotation and clinician action steps toward objective running assessments Guest Introduction: Experts in Running Biomechanics and Strength-Based Performance Dr. Chris Sands, DPT, OCS: Dr. Chris Sands is a Doctor of Physical Therapy and Board-Certified Orthopedic Clinical Specialist with advanced training in running biomechanics and force-based assessment. At Kinetic Physical Therapy , he co-leads the Modern Running Assessment program, using tools like handheld dynamometry, force plates, and high-speed gait analysis to quantify strength, asymmetry, and load tolerance. His work focuses on helping runners and clinicians connect objective metrics with tailored training plans that support performance, resilience, and long-term joint health. Dr. Gabe Kresge, DPT: Dr. Gabe Kresge is a Doctor of Physical Therapy and USA Powerlifting coach who specializes in strength and movement optimization for runners and lifters. At Kinetic, he partners with Dr. Sands to deliver data-driven running assessments that merge objective strength profiling, unilateral endurance testing, and individualized programming. His clinical lens emphasizes building durable, strong runners through intelligently progressed strength training, volume programming, and practical education that athletes can apply for life. Learn more: Kinetic Physical Therapy — Website: https://kineticptpa.com/ Strength, Mobility, and Volume Progression Strategies for Durable, Efficient Runners Foundational unilateral strength exercises for runners to consider Single-leg Bulgarian split squats Single-leg Romanian deadlifts Single-leg deficit calf raises Lateral band walks / hip abduction work Cadence, gait mechanics, and shoe strategy for optimized load distribution Trial modest cadence adjustments and monitor symptoms and perceived effort. Teach foot strike as a load-distribution choice dependent on goals and physiology, not as a right-or-wrong pattern. Encourage shoe rotation and prioritize comfort and function over marketing claims. Disclaimer: The views expressed on this podcast are those of the hosts and guests and don’t necessarily reflect those of Fullscript or any affiliated organizations. This podcast is for informational and educational purposes only and is not intended to be medical advice. For your safety, always check with your doctor or healthcare provider before making changes to your health routine. Citations Rønnestad BR, Mujika I. Optimizing strength training for running and cycling endurance performance: A review. Scand J Med Sci Sports. 2014 Aug;24(4):603-12. doi: 10.1111/sms.12104. Epub 2013 Aug 5. PMID: 23914932. Altman AR, Davis IS. Prospective comparison of running injuries between shod and barefoot runners. Br J Sports Med. 2016 Apr;50(8):476-80. doi: 10.1136/bjsports-2014-094482. Epub 2015 Jun 30. PMID: 26130697. Llanos-Lagos C, Ramirez-Campillo R, Moran J, Sáez de Villarreal E. Effect of Strength Training Programs in Middle- and Long-Distance Runners' Economy at Different Running Speeds: A Systematic Review with Meta-analysis. Sports Med. 2024 Apr;54(4):895-932. doi: 10.1007/s40279-023-01978-y. Epub 2024 Jan 2. PMID: 38165636; PMCID: PMC11052887. Prieto-González P, Sedlacek J. 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