Dear Doc: I'm about halfway through my military career and, if I have learned one thing, it's that we are all about running. I run for my physical fitness assessment twice a year, I run with a full "battle rattle" on when we're out doing field training exercises and, as if that wasn't enough, I run two or three miles for my own workouts four or five days a week. Thankfully, up to this point, I haven't had many problems, but I've noticed that the older I get, the more intense the pain and tightness is and the longer it lasts. Sometimes I even have to steady myself on the side of the bed when I wake up in the morning for fear of my ankles giving out or twisting.

The military "tough guy" in me tells me to push through the pain. The logical guy who doesn't want to destroy his body tells me I should probably make sure I'm not pushing myself too hard. Does this long-term damage add up? Should I be doing something different? Should I slow down? What can I do to make sure I continue to be battle ready for the rest of my career and beyond?

-Running and Gunning

Dear Running: You are absolutely correct. We do love running. If you're smart about it and take the proper precautions and listen to your body, however, you should be able to continue to do it, and do it well, for years to come.

I got a chance to talk to Lt. Cmdr. Aaron Stoll, a physical therapist at Naval Hospital Jacksonville in Jacksonville, Florida, about this and here's what he had to say about it:

Running is an integral part of military culture. It's part of all branches' physical fitness tests, a tactical necessity, and the basis of most other types of athletics. Outside of the military, running is still probably the most popular form of exercise because it's something that essentially everyone has had some experience with, and can do (to some extent) without extensive coaching, expensive equipment, or membership to a gym or club.

Managed properly, most of us can be runners throughout the majority of our lives. Of course, there may be major structural injuries which put a cap on our ability to run, or at least make it a less effective option. But for most of us, running "injuries" are usually recurrent or nagging aches and pains; that start and progress without obvious injury. These non-traumatic conditions usually fall into one of two categories:

1. Training errors/overuse – The body's tissues need time to adapt to stress. Rapid increases in the intensity, duration, or frequency, as well as road surface changes, can contribute to irritation of bones, ligaments, tendons, and muscles. A good rule of thumb is to add only 10-15% per week to mileage in order to give your body time to adapt. Aches, pains, and declining performance can be signs that you're overloading and need a couple days off to recover.
2. In other cases, our body is not prepared for the stresses of running. While running may seem like a simple, straight-line exercise, there is movement happening in all 3 major planes, and we need both mobility and strength in those planes at all involved body regions. For instance, an ankle that has become stiff may result in excessive flattening of the arch resulting in arch pain often called plantar fasciitis. Hamstring tightness might cause a shortened stride, which can cause pain at the front or side of the knee that may be called patellofemoral pain syndrome, runner's knee, or IT (iliotibial) band syndrome. Others may develop hip or back pain with running due to stiffness of the leg muscles or trunk. While these types of conditions are not usually a sign of serious injury, they can and should be dealt with to prevent worsening of the symptoms and optimize continued performance.

While these are often not true injuries, if they're inhibiting your performance, there's likely an underlying reason (beyond the mere passage of time), and likely something to be done about it. Programs like yoga and Pilates can help improve and restore mobility if regularly utilized and participating in different types of sports or strength-based cross-training programs can help expand your movement toolkit to make running less stressful. If these strategies don't seem to help, it would be wise to lean on someone with movement expertise (a personal trainer, strength coach, athletic trainer, physical therapist, etc.) to observe your movement, help you understand where you may have lost some mobility or strength, and point you on a way to get it back.

In the end, running can and should be something in which we can all participate throughout the course of our lives. The issues that typically come with running can be well-managed with proper training methods and some attention to our overall ability to function in a variety of positions and movements that are not accomplished by running alone. We're designed to participate in a wide variety of physical activities, and if we become too narrowly focused, our tissues can become aggravated.

Running, the bottom line is that, no, you are not running too much. The pain is likely normal and with some subtle changes in the way you are working out and preparing or recovering from your runs, you should be able to minimize the short-term impacts on your body.

If you think it may be something more serious, you should definitely start by talking to your primary care physician, but if it's not, changing things up a bit using some of the tips Lt. Cmdr. Stoll suggested should help. "Managed properly," like the Lt. Cmdr. said, "most of us can be runners throughout the majority of our lives."

Take care out there!