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Every morning, Julie puts on her sweats, laces up her sneakers and sets out on her morning run. Rain or shine, she takes to the streets and logs just over four miles in an hour. Like a legion of dedicated fitness buffs, she has made running an integral part of her daily regimen.

Without question, running is one of the most popular cardiovascular pastimes. Millions partake in the activity each year. Young or old, man or woman, running transcends all demographic bounds.

However, while running certainly provides a variety of health-related benefits, it also has a downside: statistics show that as many as 65 percent of all runners will, at one time or another, experience a training-related injury . Chondromolacia (runner's knee), heel spurs, shin splints, bunions and iliotibial band syndrome all are common ailments experienced by those who run on a frequent basis . Most of these injuries are related to overuse , which develop when muscle, bone and/or connective tissue are subjected to repetitive stress. The cumulative effect of these stresses causes structural damage at a rate greater than that at which the body can repair itself. Ultimately, the injuries become chronic, often leading to severe conditions such as osteo-arthritis and joint degeneration.

Women are especially susceptible to the debilitating effects of running. Since women have naturally wide hips (to accommodate the demands of childbirth), they tend to have larger Q-angles (the angle formed between the knee and hip) than their male counterparts. A large Q-angle has been found to heighten the amount of knee torque during impact activities such as running . As the Q-angle increases, the proximal femur is displaced laterally, causing increased patellar tracking problems when subjected to high force maneuvers. As a rule, the wider your hips, the greater the risk for injury.

Furthermore, in comparison to men, women tend to have greater laxity of the patellar ligaments . This decreases the sensitivity of the knee joint, making it vulnerable to damaging forces. Accordingly, when the lower extremitites are subjected to impact, there is a heightened prospect of injury to the connective tissues, particularly the anterior cruciate ligament.

Fortunately, the perils associated with running can be substantially mollified, if not completely eliminated-provided you take the proper approach. By adhering to the following protocols, you can continue to reap the rewards associated with a running program while significantly reducing the prospect of injury.

Proper footwear is an important component in exercise safety . A good running shoe acts a shock absorber, alleviating some of the ground reaction forces associated with running.

Unfortunately, the choice of footwear is all too often taken for granted. People tend to buy sneakers based on ethereal factors such as aesthetic appearance or even celebrity endorsement. This is a big mistake! You can't wear just any shoe and expect to receive adequate protection; those made for activities other than running (i.e. basketball shoes, tennis shoes, etc.) simply don't provide enough support and cushioning to guard against running-related anomalies.

Ideally, you should wear shoes specifically designed for running. A good running shoe should have the following: extra heel cushioning to mitigate impact; an upward curve at the heel and toe for smooth heel-to-toe transition; waffled outsoles to enhance traction; and an "Achilles notch" to reduce stress to the Achilles tendon. In addition, the sole must be soft-but not too soft. An overly soft sole can bottom out quickly, unduly transferring impact to the joints and connective tissue.

For those with podiatric conditions such as excessive pronation or leg length discrepancies, customized orthotic inserts are advisable. Orthotics help to correct imbalances of the lower extremity and restore normal ambulatory function . With the proper fit, superior results can be achieved.

Generally speaking, running shoes should be changed every 500 miles or so. For a frequent runner, this equates to about a couple of times a year. Those who are heavier might need to change their shoes even more often. Since shoes can appear to be in good condition but fail to provide adequate support, it's best to heed the old adage: when in doubt, throw them out!

Poor flexibility has been implicated as a major cause of injury during running . Like an overstretched rubber band, tight muscles are susceptible to strains or tears when exposed to large tensile forces. Generally speaking, joints with a reduced range of motion have a greater the predisposition to injury.

Flexibility training (i.e. stretching exercises) can help to counteract this problem. A well-designed stretching program improves soft tissue elasticity, allowing joints to move freely throughout their intended range. But while it is important to stretch all the muscles of the lower body, particular attention should be paid to the hamstrings and calves. More than another muscle group, they tend to be excessively tight and therefore are especially prone to exercise-related injury .

As a rule, stretching should be static, where you slowly work into each stretch in a controlled fashion. Static stretching is one of the most effective way to achieve optimal benefits without potential damage to your musculature. It allows for a gradual elongation of muscle tissue, permitting you to safely stretch your body to its utmost degree. It is best to avoid some of the jerky, bouncing maneuvers employed by some runners. These types of ballistic movements can easily overload soft tissue structures beyond their normal elasticity, causing potential harm your muscles, joints and connective tissue.

When you stretch, go only to the point where you feel tension in the muscle-not to where you experience unbearable pain. If you stretch too far, your body sends a neural impulse to the overstretched muscle (called the stretch or myotatic reflex), causing it to contract. This reflex actually tightens the muscle, creating the opposite effect of what you are trying to accomplish. By stretching slowly, you can ease into a comfortable zone, taking your body to the edge without going over. Finally, make sure to keep yourself loose and relaxed, breathing in a slow, rhythmic fashion.

During a run, joint compression forces can be in excess of four times bodyweight. For example, during a run, a person weighing 150 pounds puts in excess of 600 pounds of downward pressure on the lower extremities each time their foot strikes the ground. That's a lot of force!

To help offset some of these forces, you should choose a running surface with good shock-absorbing properties. A quality treadmill is ideal for this purpose. It has a cushioned deck that is specifically designed to reduce impact. Hence, joint-related stresses are kept to a minimum.

Many people, however, prefer to run in the great outdoors-and who can blame them? Fresh air and sunshine during exercise can be very therapeutic and provide a sense of being in touch with nature. If you do decide to go the al fresco route, though, avoid running on pavement. Opt instead for a well-maintained track, perhaps at your local high school or college. If you live near the ocean, an even better option is to run on the beach. Sand has a lot of "give" and therefore is easy on the joints. What's more, it actually provides more cardiovascular benefits; energy expenditure is increased by more than 50 percent when compared to running on a hard surface .

Another alternative is to engage in weighted speed-walking. Weighted walking increases energy expenditure to values usually observed with running with far less compression forces. In fact, the intensity of weighted walking at 4 mph is comparable to running at 5 mph . The impact force on the leg while running is equal to about three times body mass whereas the level of leg shock from walking is only 30% of this value. Using hand-held weights or a weighted vest is preferable to ankle weights. The latter can alter running economy, thereby increasing the risk of injury.

One of the most overlooked aspects of running is technique. Since the act of running is learned at an early age, little thought is put into its biomechanics. But how you run is critically important in the way that stress is distributed throughout the body.

Roughly 80 percent of all runners strike the ground heel first. Doing so, however, can cause potential problems. In heel-strike running, the leg is fairly stiff at the point of impact, resulting in a high level of shock. Consequently, compression forces are magnified, heightening stress to the lower extremities.

A better alternative is to strike the ground with the midfoot-a practice supported by the majority of elite runners . A midfoot strike requires that you flex your leg upon impact. This helps to dissipate some of the ground reaction forces and therefore reduces the amount of shock to your body. Don't expect this adjustment to be easy, though. You have to effectively "unlearn" basic motor patterns that have been established over many years. But with consistent practice, the new style will become ingrained into your subconcious and optimal benefits will be attained.

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