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With the Christmas period and New Year now but a distant memory, NOW is the time to kick start your running training and a pre-hab training plan ahead of the London Marathon. With this Spring seeing a return to the traditional April slot for the London Marathon, entrants will need to start building up the training miles with a view to reaching peak training in March before tapering into the last 2-3 weeks for the big day on 23rd April 2023.

We spoke to, Dr James Thing, Consultant in Sport, Exercise and Musculoskeletal Medicine and Founder of The Joint Injection Clinic, in Golders Green and Chelsea, and veteran of 13 marathons gives his top tips on exercising through the colder, darker months, in the run up to getting race-ready for London 2023.

Get strong along the way

If you’re planning on running 26.2 miles, of course it is essential to have a baseline level of cardiovascular fitness, focusing heavily on running training but it is also beneficial to incorporate alternative exercises such as cycling, the cross-trainer and swimming.  It is also important for runners to build in strength and resistance training alongside the cardiovascular endurance training.  This resistance work helps to complement the cardio training and can result in fewer injuries and less time loss from running training.

Squats, glutes work, upper body weights training and core exercise can help optimise running performance and improve marathon times.

Dr James Thing, Consultant in Sport, Exercise and Musculoskeletal Medicine and Founder of The Joint Injection Clinic
Dr James Thing

Run, rest, repeat:

The repetitive force of long-distance running naturally puts a huge strain on the joints – and, while strength and conditioning can help to reduce injury, your body also needs to rest. Every runner is individual and the intensity of a run can vary, so it’s hard to “prescribe” a specific amount of rest days per week. However, runners training for the marathon should aim for between 2-3 rest days each week. Those rest days can include light exercise as long as recovery remains the priority.

It’s also important to be in tune with your body. If you feel a niggle or are overly fatigued, and you continue to train, you’re likely to only exacerbate the problems and run the risk of long-term damage. Sleep itself is also vital to performance, as a lack of quality sleep can adversely affect post exercise recovery.

Dr James Thing, Consultant in Sport, Exercise and Musculoskeletal Medicine and Founder of The Joint Injection Clinic

Eat healthily and stay hydrated. 

It is essential for runners to refuel after exercise and to consider how best to recover and adapt to endurance training.  Protein is a vital component in any runner’s diet.  Marathon runners will have at least 50% greater protein requirements than the average person.  Protein helps us to recover post-workout and can help with injury prevention. Before a run it is important to have fuel on board.  A sensible-sized balanced meal (proteins and carbohydrates) at least 60 minutes before a run is ideal. During the run it is important to have refuelling options such as easily digested bars, gels or glucose tablets which can provide rapid energy on the go.  Make sure that you have trialled these options in training.  There should be nothing new and no surprises on race day!

With both eating and drinking while running long distances it is important to remember to start consuming before you feel hungry or thirsty otherwise you may have missed the boat and your performance may already have been affected. After a run it is important to refuel with a balanced meal focusing on carbohydrates and protein within the first 30-60 minutes.

The general rule of thumb with fluids and hydration is to replace 500mls per hour however this will vary dramatically depending on the temperature, intensity of effort, size of the runner and their normal sweat losses. 

Dr James Thing has ran 13 marathons

One of the most accurate ways to assess hydration is to weight yourself before and after a run and calculate your rough losses for a particular distance or time.  You can then use this as a guide to fluid replacement on race day.

Warm up winter training:

The most common problems that we see in Clinic in Winter run-up to big races in the Spring are muscle injuries, most likely as a result of an inadequate warm up and going from a cold environment to full activity before preconditioning the larger muscle groups, i.e. hamstrings, calves, quadriceps. We also see an increase in bone stress injuries such as stress fractures as some people will start their marathon training too aggressively and go from a low-level baseline fitness to running regularly without building up gradually.  This rapid increase in training can precipitate bone injuries, as well as issues such as medial tibial stress syndrome (shin splints). To help muscle recovery, make sure you take time to stretch and supplement this with lighter exercise on rest days like yoga or pilates. Not for the faint hearted, but now increasing popular – ice baths and cold showers can reportedly help reduce inflammation of the tissues and joints, relieve soreness and speed up recovery.

marathon training pre-hab

Know your niggles

Osteoarthritis affects 8.5 million people in the UK1 and can cause pain and problems with normal knee function, which has a detrimental affect on quality of life. If you’re suffering, it’s worth considering speaking to a physiotherapist or doctor about your pain. They will usually recommend a combination of exercise treatment and caution with aggravating activity but may also discuss injection options, including steroid and hyaluronic acid (lubricant) injections.  For patients with established knee arthritis it is also worth looking into some of the new innovative and minimally invasive treatment options like Arthrosamid® – a single hydrogel injection that works to cushion the knee joint, reducing the patient’s pain, decrease stiffness and help movement. It has been shown to the safe and can give long-acting relief, improving quality of life2 . There are no serious side effects related to the hydrogel, and following the guidance from your doctor, successful outcomes can be noted within 4-12 weeks2.

Dr James Thing, is a Consultant in Sport, Exercise and Musculoskeletal Medicine and Founder of The Joint Injection Clinic

Looking for an afforable place to stay during the London Marathon? Our preferred partner is Premier Inn and they have a number of great hotels in and around London.


  2. Bliddal, H., et al. (2021). Polyacrylamide Hydrogel Injection for Knee Osteoarthritis: A 6 Months Prospective Study. J Orthop Res Ther. 6(2). 1188. ISSN 2575-8241.
Andy Barr
the authorAndy Barr
Editorial Lead
Andy was late arriving into the world of fitness, running and training. He did not really take up regular gym going until he was in his late 30's. He lost over 7 stone in weight since starting and completed an olympic length triathlon in June 2018. He enjoys playing football, boxing and outdoor running.

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