How to get the marathon result you want and know you deserve!

You’ve been pounding the pavement for weeks if not months in preparation. Honing your body and figuring out all the details like the right hydration and nutrition on the day. Maybe you’ve run a few test events in the run up. You’ve spent hours training, put off social engagements and neglected friends and loved ones in the lead up to the London Marathon.

So, how do you guarantee that you’ll perform your best on the day? How do you make sure that all the hard work doesn’t amount to disappointment? How do you avoid the “if only” feeling of missing out on the target you’ve set yourself?

The five points of performance

Well, I decided to consult James Parris of Parris Performance Coaching to get his take on success. James is a Performance and Behavioural Change Specialist.

Having coached Elite sport for over 15 years, the ONE thing that James found that works is a model called the 5 Points of Performance. It’s a simple model you can use for your sporting endeavours and anything else in your life you want to succeed at.

The 5 points are – circumstance, thoughts, feelings, actions and results.


Usually, people focus on the circumstance they find themselves in, which is generally NOT what they want. This leads to negative thoughts, which in turn makes them feel bad in some way. Feeling bad means that they don’t take the right actions and that leads to a poor result.

Focus on the result you want to get

What works is to focus on the results you want and reverse engineer a way of getting there.

You’ve heard it said a million times that you can’t change the circumstances you find yourself in. Only by getting the results you want will you find yourself in the circumstances you wish to have.

You’ve also heard it often said that you need to set goals if you want to achieve something. This is exactly right, but often it’s left at just that, a big hairy, lofty goal. Very few people think to actually engineer the steps to make their way to hitting the goal. Break it down into smaller bite size pieces.

So, let’s draw a line under the circumstance you find yourself in during the Marathon and set it to one side. Now, let’s work the model backwards from the results you want.


Use all the standard goal setting tools you’ve previously heard about be it SMART (Specific, Measured, Achievable, Realistic and Timed), or which ever. Now write the goal out as if you have already achieved it, beginning with “I am”, or “I have”. Like this – I have run the London Marathon in a time of 3 hours and 55 minutes. I did this by running 9 minute miles, drinking a cup of water every 5 miles and having a gel every hour.

Now you need to make this into a Daily Declaration which you repeat to yourself every morning and evening in the lead up to the race.


Now you can move onto the exact actions you need to achieve the result you want. You want to map this out in minute detail. A great way of doing that is by using the Escape and Arrival framework.

This maps out the thing you want to Escape from – the current personal best you want to beat or maybe it’s ‘not having run a marathon’ – and marks out the exact steps you need to take in order to Arrive at the thing you want – a specific new personal best or ‘having run a marathon’. Along the way you write out the keystones you need to act on in order to progress to the next. I’ll give you a silly example – Escape from having an untied shoe lace and Arrive at having a tied shoe lace.

First keystone would be to check that you’ve got the shoes on the correct feet. Next keystone, pick a shoe to tie – left or right. Next take a lace in each hand. Next place the left lace over the top of the right lace. Next, tuck the bottom lace under the top and pull through. Next, make a loop with the left end and squeeze tight at the bottom. Next, wrap the right end around the loop where you’re holding it. Next… you get the picture!

You can even take each keystone and map out an Escape and Arrival for that as well. This gives you the exact map for your perfect marathon and will stop you procrastinating in the run up and during the race. Most people procrastinate either because the don’t know where to start or because they get lost half way through and don’t know what to do next.

The Escape and Arrival framework takes both of these ambiguities away.


Just having your progress and the race plan mapped out in front of you will likely make you feel much better about performing on the day.

However, if you’re still feeling a little anxious, try some Super Suggestion. Super Suggestion works a little like post hypnotic suggestion, in that you place the feeling you want into your mind during a period of relaxation.

Self motivation concept. Negative words cut with scissors and became positive.

It’s been scientifically proven that if, when you feel nervous, you say three words to yourself – “I am excited” – your performance will be better. Super Suggestion can implant feelings of excitement into your mind when you need them.

Sit in a cool, calm location which is nice and quiet. Close your eyes and in your head count down from 20 to 1, then say “let go” whilst feeling all the tension drain out of each and every muscle in your body. Whilst in this relaxed state, breath steadily and repeat the feeling you want to implant over to yourself. Try to stay like this as long as you can, nice and relaxed, repeating the word to yourself. When you feel like you’ve had enough, simply count back up from 1 to 20 and then open your eyes. It doesn’t matter if you’ve done 2 minutes or 20 minutes like this, you will have implanted the feeling into your mind.


Actually, I need to clarify this as Self Talk. Your internal monologue. You need to develop a positive self talk if you want to keep in the right frame of mind to be able to execute the Actions.

Post hypnotic suggestion can work the other way as well, negative self talk leads to negative feelings. Which lead to poor actions. Pay attention to the negative self talk you have about your training, racing or the London Marathon specifically. Note them down whenever you have a moment of negative self talk and read it back to yourself aloud. Listen to how irrational it sounds when doing this.

You must eradicate your negative self talk. Put yourself up or shut up.

There you have it, your performance for the London marathon mapped out using the 5 Points of Performance. Take some time to work the model through and don’t leave anything out.

Good luck on the day from James Parris and our team of therapists at Physio on the River!

Next steps…

If you would like to contact James Parris for more information on how he can help with sports performance please email him at If you would like to make a Physiotherapy appointment for a marathon injury then please call the clinic on 020 8876 5690 or email us here.

Our running clinic specialists can give you a running assessment and advise on improving running performance, avoiding injury and recovering from problems.

Other running articles by our specialists

Striving to be well heeled: part 2

Painful steps forward…

Woohoo! At about 6 weeks post injury I had my first full, undisturbed night’s sleep – luxury!

Also, I was starting to push the rehabilitation beyond the ‘one size fits all’ protocol I had been given. I should say here – this was only because, as a Physio, I know what is safe to push and what mustn’t be compromised where rehab is concerned. I know when to be gentle and when care is less important – so please don’t think that without medical knowledge it’s okay to push the envelope.

My progress in rehab

Standing balance practise

The exercises I was doing included pointing my toes against a low resistance exercise band, sitting and standing with equal weight being taken through each leg, coming up onto my toes in a sitting position (so there is much less weight through my leg compared to standing), balancing on my left leg only and also lots of walking practice without the boot. This I did very slowly and with rails or the help of a wall for support, as needed.

I continued with daily brief massages and I managed to ditch the crutches. By 8 weeks I was allowed to remove the last wedge in my boot, increasing stretch on the tendon. So I was walking in the boot in a flat foot position 2 weeks ahead of schedule. Progress at last!

I’ve spent years instructing my clients in what to do at home but it’s not so easy to consistently commit to doing it oneself!

Achilles tendon and calf massage

Lessons learnt

An excellent lesson I learnt at this stage was to keep the bigger picture in the distance and to really focus on the small milestones that can be achieved, something I will utilise more in encouraging clients with their rehabilitation than perhaps I had done previously.

Of course, it hasn’t all been sunshine and roses in this second stage – I have had more pain than previously. This is not altogether surprising given the increasing loading on the tendon in day to day activity and the heavier and greater exercises I have been doing. But the pain has been good pain – in that it represents the progression of what I am able to do. I know it’s something I must respect but nothing to be concerned about.

change your mindset concept

This stage of the rehab journey has been encouraging and I have been able to maintain a more positive mindset and see the potential for full recovery. All recovery has ups and downs but I’ve been able to see an overall upward trajectory.

One of the more challenging aspects has been weight gain! I have not considered reducing my food intake to match the reduction in activity. This now means I have an extra motivation to keep working hard not only to regain full use of my Achilles tendon but also to reduce my girth! I realise I should have made adjustments.

If you are struggling to recover from an injury and need Physiotherapy treatment give us a call on 020 8876 5690 or book an appointment using the Book Now button on this page.

Striving to be ‘well heeled’!

If you have visited the clinic recently you may have seen two of my Physio colleagues on crutches! Not a great advertisement for our profession.

As a clinician I think it helps to have gone through an injury or surgery yourself as it gives you a deeper understanding of both the physical and mental challenges a long period of rehab involves.

So when Richard broke the news to me that he was on crutches with a significant injury I thought it would be a good opportunity for him to diarise his recovery and share insights from both sides of the fence.

Read on to hear the first part of Richard’s journey, coping with a full Achilles Tendon rupture.

Part 1. A Loud thud and sleepless nights…..

In an ever more challenging target of remaining fit whilst ageing, I’d been participating in a CrossFit class. CrossFit is like circuit training with a bit more lifting of sand bags and explosive movements.

After a good warm up and loading exercises, I was on the 4th length of sprinting….with a resistance belt and a tyre for extra load…in heavy mud….and in studded boots. At this point, most people say to me “at your age?!”. Cold, tactless, but essentially a fair point.

Anyway, I felt (and heard) a sudden deep thud at the back of my left calf and lost all power, falling to the ground. There was some physical pain, but nowhere near as much as the emotional pain of knowing exactly what injury I’d sustained as it was absolutely as the text books I first read over 20 years ago, described.

Cutting a long story short, I had a trip to A&E for a precautionary x-ray and a plaster cast was fitted. I was given a follow up orthopaedic appointment 3 days later where the protocol for non-surgical management of a full Achilles rupture was outlined to me. Sadly, it confirmed the grim pathway ahead.

Ankle walker use to provide support

I was fitted with a large, cumbersome, heavy boot which had 4 removable wedges inserted under my heel. These were to keep the tendon held in a shortened position so the ends could come together and heal without being put under any load or stretch. The wedges would be gradually removed  one at a time over the following weeks.

I was only permitted to remove the boot for bathing which meant that for the worst part of the first 5 weeks, I had to try and sleep in the boot. A snug fitting, heavy furnace around a lower leg that hurts is definitely not conducive to sleep!

I continued to work, using 2 crutches, gradually weaning to 1 crutch and took the boot off 3 times daily to bathe/shower, for a couple of self massages and to wiggle my toes.  It was very much a challenging time and definitely not the best image for a Physiotherapist to flaunt. But even Physios are human and sustain injuries.

Orthopedic aids

At home I have three teenage sons all still at school and requiring ferrying Dad duties. Our car is a manual and so driving was out of the question. The lack of independence and the reliance on my family to get me places was incredibly frustrating.

Even if I didn’t have a history of low mood and anxiety, this was going to be mentally very challenging. I have always kept active: playing basketball, Judo, rugby coaching, cycling everywhere and that’s not even including climbing, running, jumping and general tomfoolery with the kids!  So it was essential that I considered strategies to cope with this.

I have used 3 main principles:

Acceptance – understanding that I need to find the right balance between pushing myself and respecting the physiology of the healing process.

Opportunism – whilst accepting this places considerable limitations on my lifestyle, I have used it as an opportunity to understand coping with enforced rest, work on my mindfulness and breathing and re-visit a much-played game in the past, Scrabble!

Championing the little things – The smallest of goals achieved has been really useful as a motivational tool to continue with the patience and trust in the process of rehabilitation. Walking down stairs with 1 crutch, taking a wedge out of the boot, having a shower and not a bath have been important, small milestones to keep me motivated.

If you are struggling with lengthy rehab following an injury or surgery, our Physios are not only very well qualified and experienced but have had the misfortune to be injured themselves and can help keep you going through your rehab journey!

Next steps…..

To make an appointment call us on 020 8876 5690, email us here or simply pop in to chat it over with a Physio.

Teenage sports injuries: prevention and management


teenage gymnasts

The group of modern ballet dancers jumping on grey background

One of the greatest things about being a teenager is that you can run, jump, bend and reach in the ways we can only wish for as we get much older.  But having such a high performance machine requires high performance maintenance and care.

Furthermore, without the necessary care and maintenance, teenagers can be prone to injuries keeping them away from sport – from nagging niggles to more demoralising and chronic debilitating injuries.

Fear not! Armed with the right knowledge, injury risk can be minimised and should the worst happen and you do develop a problem, knowing how to manage your way back to sport can be a useful skill and can better your performance in the long run.

In this blog, Richard Game, one of our team of Sports Physios talks about types of injuries and issues, why teenagers might get them, how they can be managed and more importantly, what to do to prevent them occurring where possible. Richard has three sporty teenage boys of his own – so he speaks from a place of experience!


The key to best managing sports injuries in older children, teenagers and young adults is the appreciation that they ARE NOT the same as adults.  The physiological properties of their body tissues, their various stages of growth and their growth rate can all vary hugely and all require careful consideration when assessing and treating them.

teenage skeletonThere are 2 main growth spurts in children and teenagers, coinciding with hormonal changes, as the child progresses from infant to child.

The first occurs at 6 or 7, but most relevant for this discussion is when puberty occurs. The timing of this spurt varies between girls and boys with girls being slightly earlier at 8-13 years and boys at 10-15 years.

The hormonal driven changes cause increased activity in the area of bones where growth occurs which is called the ‘growth plate’.  The rate of this can vary greatly – with some adolescents growing relatively slowly over longer periods, whilst others seem to shoot up almost overnight!

Therefore, it is really important that teenagers with musculoskeletal pain are suitably assessed and, here at Physio on the River, we have several team members who have a lot of experience working with sporting teenagers and understand the various challenges and issues this cohort bring with them.

Types of sports injuries

These can be broadly split into two types:

  1. Traumatic injuries – these most commonly happen in competition or training and includes things such as sprained ligaments, torn muscles, fractures, tendon injuries and haematomas (large bleeds into a muscle).
  2. Overuse injuries – these can build overtime or suddenly become evident by causing pain, swelling, strength loss and a reduction in sporting performance. Examples of these include conditions such as: Chondromalacia patella and Osgood Schlatter’s disease in the knee, Pars defects in the spine, Severs disease of the heel, shin splints and tendonitis.


There are several different aspects to injury prevention in younger sports people.  Most importantly to say right away, is that if you think you have a problem and it’s either not improving or your problem is distressing because of pain, then it’s essential that you see either your physiotherapist or doctor to have a thorough assessment.

It’s not ‘normal’ to have pain other than perhaps post exercise muscular fatigue and pain could be indicating something else that needs medical attention.

Common Issues Physio Solutions
Over training – Too high a volume of training/competing, too heavy loading of tissues, lack of variety in movements and loading Training smarter – Your physio can help you develop a training program that enables optimal performance AND minimises injury risks from over-use.
Growth related issues – ‘growing pains’ can be very real, can prevent full movement and function and severely limit sporting activities Understanding your body – We can help you understand what are growing pains, what are training pains that are normal and what may be an injury or overload AND advise you how to manage this
Poor technique – inefficient movements or poor technique causing overload of tissues and increased stress and strain on the tissues Doing it right – Making sure you are performing techniques correctly, reduces excessive lading of tissues AND will enhance efficiency and help you perform at your best
Inadequate/wrong equipment – often adapting movements to accommodate adult equipment that is too big The right stuff – We are able to advise you on equipment from footwear to bikes and taping to padding.

And finally a brief word on weight training…

It is very ‘fashionable’ in society at large to engage in weight training – whether that’s a 50-year-old Mum doing 70 kg dead lifts at the gym, a 25 year old sculpting their body for social media posts or a young sportsperson trying to get stronger for their sport. What is important is that teenagers respect the level of maturity of their skeleton and load it accordingly.

teenage rugby playersFor example: let’s look at 14-year-old rugby players Ollie and Billy. Ollie is 6’1”, weighs 78 kg and is just about the same height as his father but 30 kilos lighter.

Billy, on the other hand, is 5’3”, weighs 46 kg and is 7” shorter than his father and 45 kg lighter.

They are both in the A team for rugby in their school year.  Clearly the boys are similar in age and level of sport being played, BUT they are not at all the same in their physical development.

As physios we would help Ollie develop a strengthening program using free weights, lifting heavy weights and ensuring technique is correct. We would not however encourage such an approach for Billy who is presently less physically mature. We would  perhaps use resistance bands and body weight exercises and maybe light weights instead, as he would be at far greater risk of injury.

It is this evidence based and reasoned approach to managing sports injuries and performance in teenagers that allows us to achieve great results.  We are always happy to screen teenage sports players and can advise on training regimes that are tailor made for them at their unique stage of development.

Next steps

If you would like to find out more or want to discuss your teenager’s injury with Richard or one of our team of Physios, just:

Call the clinic on 020 8876 5690

Email us here

Book an appointment online

Or pop in to the clinic for a chat!

Hear how Physio Dave helped a keen runner with persistent Achilles Tendinopathy

I recently caught up with one of our keen running clients, Patrick, who came to the clinic complaining of chronic Achilles Tendinopathy. Read on to find out how Physio, Dave Burnett, helped Patrick recover so that he could return to distance running again.

Hi Patrick- tell us a bit about yourself and what sport and exercise you do?

As a retired rugby player and triathlete my body has taken a bit of a battering over the years. Nowadays I cycle as my main sport but still enjoy running and swimming.

How and when did you develop your running Injury?

Achilles tendinopathyIt was probably a combination of not warming up properly, pushing too hard and the uneven surface that must have aggravated my Achilles tendon problem. When you are only a short distance out the tendency is to keep going to the end which probably just aggravated the situation even further.

What did your physiotherapy involve and how did you find it useful?

Dave at Physio on the River was great! Things were made easier as I was being treated by him for a shoulder injury at the time and he saw me hobble in and immediately diagnosed the issue – which was a Chronic Achilles Tendinopathy. So, after a couple of sessions of manual therapy treatment and stretching exercises for the calf, hamstrings and glutes (buttocks) we started the Shockwave treatment.

Describe your experience of shockwave therapy?

Shockwave for the achilles tendonI had 4 sessions of Shockwave which involved getting hammered by metal pads 100 times a second! It hurts the first time, although I think this was psychological and then after that it became quite therapeutic!

Whilst you mustn’t run immediately after the treatment, you can stretch and it’s important to do loaded strengthening exercises.

Every week I felt some progress. Once we had finished the Shockwave sessions we were able to progress to more explosive “plyometric” exercises. Apart from a blip when I may have done too much too soon, I was able to gradually build up the time and distance I was running and eventually the pace.

I am making great progress now. The important thing is to listen to your body and take your time. When you get injured after 50, it’s about managing the condition. The shoulder injury also helped as it forced me to go swimming and I was able to do more rigorous plyometrics in the pool. The positive benefits of swimming are extensive!

How are you getting on now and have you achieved your goals?

I’m in a good place now and am hopeful of continuing Park Run regularly and getting to that all important 22-minute milestone. My ultimate aim is to get back to half marathons.

What’s your brief understanding of how to manage your Achilles tendon problem in the long-term?

Should it return I should first  reduce the load, gradually re-load, add plyometric exercises and load even more -with marginal increments and take my time! Thanks very much Dave!

Thanks, Patrick, for sharing your story and illustrating so nicely how we treat and help people manage chronic tendon problems like yours.

Next steps….

If this has struck a chord with you and you’re suffering with a tendon problem, to make an appointment with Dave just:

Book online

Call 020 8876 5690

Email us here

Or pop in for a chat!

12 top tips for avoiding a skiing injury this Spring!

At Physio on the River we work closely with the Orthopaedic Consultants at Wimbledon Clinics (at Parkside Hospital) who are specialists in managing skiing injuries. They are experienced and keen skiers themselves so understand the sport completely. If you are unlucky enough to get injured this Christmas or Spring we can refer you quickly to their fast track clinic for injured skiers.

However, prevention is so much better than cure!

We run a Get Fit to Ski class to help you prepare for the slopes and we will be continuing this class in the New Year to help those preparing for the half term or Easter holiday break. The class is Physio led and covers all aspects of fitness, flexibility, strength and conditioning and balance to get you in tip top condition. It’s also a great way to shed those extra pounds put on during the festive period!

Jonathan Bell from Wimbledon Clinics has written this excellent top 12 tips for avoiding injury, which I would like to share with you in this blog.

1. Take lessons

The better your technique, the less chance you’ll put undue strain on your joints.

2. Get the right kit

Have your ski or board bindings set up by a pro because, if your bindings are incorrectly adjusted, or you borrow a friend’s skis, you’re more likely to injure your knees. In the hire shop, provide an accurate weight and estimate of your ability and don’t use boards or skis that are too short or long.

3. Have a rest day

Ignore the “first lift / last lift” banter and take a break. You’re likely to get more from your holiday. Why? Because the highest risk of an accident is after 3pm on day three of your holiday as muscle fatigue reaches its peak 48 hours after you hit the slopes.

4. Take the lift at the end of the day!

vector graphics, modern flat illustration, eps 10

Later in the day, you’ll be tired, the pistes may be icy and crowded, and there will possibly be bare patches in the snow – all of which are risk factors for injury. So take the lift!

5. Control your weight

Good advice for life is to maintain a healthy weight. It’s also good to prevent injuries. The heavier you are, the more strain you put on your knees and the harder you fall.

6. Keep within your comfort zone

Control is good, bravado is bad, and icy moguls – especially if you already have any damage to your knees – are a menace. Mogul falls can result in serious injury, especially to the shoulder in
firm conditions.

7. Minimise alcohol at lunchtime

Alcohol slows your reactions and makes you more reckless.

8. Be careful getting off the chairlift

It’s easy to fall when trying to get off a chairlift. And, while it might be funny, it can be serious. We also see many people who’ve ruptured their knee ligaments when the person next to them
falls across their skis.

9. Ski off-peak

The quieter the slopes, the less danger there’ll be of being called on to take sudden evasive action. If your ability allows, learn to ski off-piste where it’s often quieter. Do make sure you learn about the risks before going off-piste and have the correct equipment and insurance.

10. Don’t wear a knee brace but do wear wrist guards if you snowboard

We recommend knee braces only for a small number of people. These include skiers returning to the sport with an old or partially healed ligament injury (they might want to use a hinged brace) or
those with mild arthritis (who might benefit from a neoprene sleeve).

Otherwise, skiing without a brace improves the ability of the muscles around the knee to respond effectively to the different stresses and strains. Wrist guards for snowboarding are useful and
significantly reduce incidents of wrist fractures.

11. Seek advice immediately after injury

Clinics in ski resorts are versed in treating ski injuries. Above all, do not ski with an injury – get it checked out. Even though it might be tempting to carry on skiing through an injury, ignoring it may result in a longer lay-off. Then, once you are home, speak to your physio about a referral to Wimbledon Clinics.

12. Wear a helmet

Helmets can reduce the severity of mild to moderate head injuries.

If you are interested in joining our Get Fit to Ski class or giving a loved one a voucher just:

Call us on 020 8876 5690

Email us by clicking here

Or simply pop by for a chat!

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