Imagery and Routines

Mental imagery is multisensory: effective imagery recreates not only the sight of a movement but its sound, feel and emotion, in the absence of the real stimulus. A proposed basis is functional equivalence: imagined and executed movement recruit overlapping, though not identical, motor and sensory networks in the brain. This shared activity is thought to be why imagery can strengthen motor learning and preserve skill when physical practice is limited. Imagery can be internal, seeing and feeling the action through one's own eyes, or external, watching oneself as if on video; kinaesthetic imagery, the felt sense of the movement, is a distinct and important element. Athletes use imagery to rehearse a skill or strategy, build confidence, regulate arousal and anxiety, sharpen focus and stay motivated. Imagery ability varies and can be trained, and effectiveness may depend on that ability and the athlete's preference, the relevance of the image to the task, and regular practice.

A pre-performance routine is a systematic sequence of task-relevant thoughts and actions carried out immediately before executing a skill, and is most useful for self-paced, closed skills such as a golf shot, a tennis serve, a place kick or a free throw. A good routine combines physical steps, such as a set number of practice movements, with cognitive elements, a cue word, a settling breath and a brief image of the intended action, with consistent timing. Routines focus attention on what matters, promote automatic execution, steady arousal and screen out distraction, and may improve consistency and support performance under pressure, particularly in self-paced skills. They do not reliably prevent choking. They differ from superstitions or rituals: a routine is functional, flexible and can be shortened when needed, whereas a ritual is rigid and believed to control the outcome by itself. The aim is a personalised, concise, repeatable routine.

These skills show themselves in how an athlete prepares and talks about performance. Some use imagery and routines well; others have never been taught them, and a stalled skill or lost confidence under pressure is often where the topic arises. The clinician can ask whether the athlete pictures their performance, how they prepare before a key skill, and whether it helps or has become a worry. Most use is healthy. Occasionally it is not: a routine grown rigid and time-consuming, imagery dominated by failure or reinjury, or preparation that fuels rather than settles anxiety can each signal a problem needing attention rather than more technique.

For the SEM clinician, assessment is mainly asking about current use and its effect rather than formal testing. Where imagery will be used, it helps to gauge how vividly and controllably the athlete can image, since those who image poorly may need more guided practice. Validated questionnaires used mainly by sport and exercise psychologists include the Vividness of Movement Imagery Questionnaire and the Movement Imagery Questionnaire for imagery ability, and the Sport Imagery Questionnaire for its functions. The practical judgement is whether a routine is functional or a maladaptive ritual, and whether imagery is helping or harming.

Both skills can be introduced simply and made more effective with structure. For imagery, the PETTLEP model is the practical guide: make it physically congruent (in kit and position), set it in the real environment, match the task and its real timing, adapt it as the skill is learned, include the emotion of performing, and choose a helpful perspective. Combining imagery with relaxation, a short script and a cue word, practised briefly but regularly, improves it. For routines, the athlete builds a concise, personalised sequence of physical and cognitive steps with consistent timing, rehearses it until automatic, and keeps it flexible enough to shorten under pressure. These skills are low-cost and safe, and the SEM clinician can introduce and reinforce them in rehabilitation. Structured psychological skills training, and situations where anxiety or obsessive features are prominent, are best referred to a Health and Care Professions Council (HCPC) registered sport and exercise psychologist. The yips may reflect performance anxiety, a task-specific focal dystonia or a mix, so they warrant multidisciplinary assessment, adding neurology or a movement disorders service where involuntary movements suggest dystonia.

Imagery has particular value in rehabilitation. During a spell out with injury, motor imagery and mental practice help maintain skill and the brain's representation of a movement, and support motor relearning as loading resumes. Graded motor imagery, a staged programme of left-right limb recognition, imagined movements and then mirror therapy, may be considered as an adjunct in complex regional pain syndrome (CRPS), though the evidence is limited and heterogeneous and the mechanism remains uncertain. Imagery also builds confidence and helps manage the fear and anxiety that accompany return to sport, alongside the graded return of loading. Routines contribute too: a consistent rehabilitation routine supports adherence to a home programme, and re-establishing a pre-performance routine helps an athlete feel prepared and in control as they return to competition. As always, health leads and the psychological work runs alongside the physical.

• •The PETTLEP model sets out the elements that keep motor imagery close to real performance, with supportive but heterogeneous evidence for skill, strength and pain management.
• •Functional equivalence and motor simulation, the overlapping but not identical activity of imagined and executed movement, are the proposed mechanism for imagery.
• •Pre-performance routines may improve consistency and support performance under pressure in self-paced skills, but do not reliably prevent choking, and their optimal content and teaching are debated.
• •Graded motor imagery and mirror therapy may be considered as adjuncts in complex regional pain syndrome, though the evidence is limited and heterogeneous and the mechanism remains uncertain.
• •Structured psychological skills training is delivered by registered sport and exercise psychologists, with onward referral where anxiety or obsessive features are prominent.

• •Mental imagery is multisensory rehearsal; imagined and executed movement recruit overlapping but not identical brain networks, a proposed basis for its effect.
• •The PETTLEP model (physical, environment, task, timing, learning, emotion, perspective) makes imagery realistic and effective.
• •Imagery can be internal or external in perspective, with kinaesthetic imagery adding the felt sense of movement.
• •A pre-performance routine focuses attention and aids automaticity, and may support performance under pressure but does not reliably prevent choking; it is functional, not a rigid ritual.
• •Graded motor imagery, laterality recognition then imagined movements then mirror therapy, may be considered as an adjunct in complex regional pain syndrome; evidence is limited.
• •Refer for structured skills training, or where anxiety or obsessive features are prominent; the yips need multidisciplinary assessment, including neurology where dystonia is suspected.