It’s estimated that 30 million Americans run and 10 million do so on a regular basis. It’s said that the feet absorb at least 1 million pounds of pressure during only one hour of rigorous exercise. It’s not surprising, then, that nearly two-thirds of runners will sustain injuries that may lead to discontinued exercise for at least a week.

Any deviations in the foot, such as fallen arches, can lead to a breakdown of the structural integrity of the entire body. Such breakdowns manifest as painful and often debilitating overuse injuries. You might liken an injury to a car with poor wheel alignment. Over time, abnormal tire wear appears, fuel efficiency is reduced and high-speed instability increases. And this is just the beginning.

It’s important to gain an understanding of these painful syndromes, and what you can do to fortify your body against them. The following information is not meant to replace medical advice. If you experience pain or irritation when running, stop exercising and seek the advice of a qualified professional.

The most frequently experienced running-related overuse injuries are: Achilles tendonitis, iliotibial band syndrome, patellofemoral pain syndrome and “shin splints,” or medial tibial stress syndrome. An exercise professional can help identify any specific structural imbalances and create a program that reduces or eliminates the incidence of painful overuse injuries.

Patellofemoral pain syndrome – the most common:

The most common overuse injury is patellofemoral pain syndrome (PFPS), which is a general term used to describe pain that can be localized above, below or to the sides of the kneecap. Repetitive impact on uneven surfaces increases the presence of PFPS, as well as hill training, jumping or any other activity where the knees are bent under stress.

Achilles tendonitis: The Achilles tendon (AT) is a thick band of fibrous tissue that connects the calf muscles to the heel. Its main purpose is to support these muscles and to assist in bringing the heel off the ground.

Trainees with AT may complain of pain, centralized, but not limited to, the heel, and are often aggravated by walking up stairs or hills. Redness of the skin may be present, as well as a general stiffness in the area.

Structural imbalances such as fallen arches and tight calf muscles are typically to blame for AT, as the tissue experiences limited range of motion, placing undue pressure upon the tendon and initiating microtears and inflammation. An estimated 11 percent of all running injuries are due to AT.

IT band syndrome: The iliotibial band (ITB) is another thick cord of fibrous tissue that originates from the upper-middle part of the hip and runs along the outside of the leg and to the outside of the knee.

Pain results from excessive friction of the band along the lower, outer-side portion of the thigh bone catalyzed by poor training methods and faulty movement patterns.

Plantar fasciitis: Perhaps one of the greatest contributors to foot stability and shock absorption, the plantar fascia (ligament-like tissue) runs along the underside of the foot from the heel bone to the toes.

Many sufferers complain of pain underneath the heel at the onset of exercise. Strength and flexibility deficits in the surrounding soft tissue, such as tightness and weakness in the muscles of the calves are thought to be major contributors to PF.

Shin splints: Medial tibial stress syndrome (MTSS), or shin splints, are generic terms referring to unspecific and often painful inflammation of the tissues in the front and inner portions of the lower leg. Those who run or jump are most likely to suffer MTSS, especially if there is a weakness in the shin muscles.

Structural alignment: Optimal alignment is when the body is positioned so that stresses are minimized and evenly distributed through the body’s structures. Though running is a highly complex series of movements, basic postural adjustments can prove essential in fortifying the body’s structures for pain reduction or prevention. Here are a few things to look for:

Feet should be parallel and arches neutral.

Kneecaps should face forward.

Reduce low back arch by simultaneously contracting the gluteal and abdominal muscles.

Keep your shoulders back and down and your head squared above your shoulders.

When looking from the side, you should be able to draw a straight line from the mid-foot or ankle, through the middle of the knee, hip and shoulder to the middle of the ear. A side-view, digital image can help you become more aware of strength and flexibility deficits.

Self-massage: Muscle tightness can prevent full-muscle contracture, placing excess stresses on inferred tendons, ligaments and joints. Myofascial release, or self-massage, is an effective form of tension release that allows muscles to return to more natural ranges of motion. If you experience tightness or irritation along the underside of the foot, for example, you might relieve tension by gently rolling the foot over a golf ball. The pressure increases blood and oxygen supply, while improving flexibility in the plantar fascia. Foam rollers, tennis balls and self-massaging tools are other useful implements for self-massage.

Strength training: Many runners tend to ignore strength training as part of their program. As mentioned above, someone who has PFPS often has inadequate strength in the thigh muscles. They are the primary stabilizers of the upper leg upon the lower leg, and if they aren’t strong enough to absorb impact, the knee joint will surely suffer. Such exercises as squats and lunges, when done with proper form, can greatly strengthen those muscles and provide them with the stability to prevent excessive knee-joint movement.

Flexibility training: As with strength training, flexibility deficits must also be tended to. For example, someone with AT syndrome might have tight calf muscles. After releasing tension with a foam roller or self-massage tool, increase flexibility by bringing the toes up toward the shin or performing some form of calf stretch.

Footwear: Shoes can make or break a successful running program. Before purchasing shoes, seek the advice of a foot specialist, as the foot is a highly complex structure comprising many small bones and muscles with potential for varied malalignments. The foot is also the first line of defense in shock absorption and should be treated with care. Here are a few tips for buying shoes:

Look for shoes with a low heel.

The hindfoot should be firmly supported and cushioned for shock absorption and control.

Shoes should have enough arch support to prevent excessive pronation. Suggest orthotics (custom-made shoe inserts) if adequate arch support is difficult to find.

The forefoot should be allowed unrestricted mobility for gripping and toe-off propulsion.

Running can be a highly effective and enjoyable form of exercise, and it’s highly possible to safeguard the body against pain and injury. A well-rounded strength, flexibility and self-massage program combined with adequate footwear and knowledge can help you maintain the running program you love.