What is really going on in a painful tendon
The Achilles tendon carries enormous forces – when you run, several times your body weight with every step. When the load grows faster than the tissue can remodel, an overload reaction follows: pain, morning stiffness and sometimes thickening. This is not classic inflammation, which is why ice, rest and painkillers on their own give only temporary relief. The tendon needs load – just given in the right dose.
The pattern of symptoms is characteristic: the worst moments are the first steps in the morning and the start of a run, after which the pain eases and then comes back a few hours later or the next day. That delayed reaction is the best indicator of whether the dose of load was right.
Therapy and the gym under one roof
The practice is based in the ZONE Fitness club at Al. Jerozolimskie 200, Warsaw. Since strength training is the foundation of Achilles treatment, it makes sense to run it where we have the equipment right there: the Smith machine, cable machines, platforms and weights that let us grade the stimulus precisely. After the manual part we move onto the gym floor and do the exercises under supervision, instead of describing them on a piece of paper.
The practice is run by a physiotherapist and strength and conditioning coach with over 15 years of experience, including work with professional athletes and members of Poland’s national teams in team sports. Choosing loads and planning a return to running is everyday work for us.
When Achilles pain needs urgent review
Chronic overload and a ruptured tendon are two different situations. If during exercise you felt a sudden snap or a feeling of being kicked in the heel or calf, and you can feel a dip along the tendon, you need urgent medical assessment – that is the typical picture of a ruptured Achilles tendon. It is confirmed by a positive Thompson test: squeezing the calf does not make the foot point down. Difficulty rising onto your toes usually comes with a rupture, but on its own it proves nothing, because it also occurs with a calf muscle strain. With a rupture a doctor decides what happens next, and physiotherapy starts later, on their recommendations. Sudden pain higher up, in the middle of the calf, with tenderness in the belly of the muscle and a tendon you can feel to be intact, more often means a calf strain.
Why the dose of load matters more than rest
A few weeks without running usually settles the symptoms, but it does not change the reason they appeared. Once you go back to your old volume the pain returns, because in the meantime the tendon has become even weaker. So we plan the load instead of removing it: we modify the training side and at the same time run a calf strength programme with increasing weight. That is several months of work, but with a lasting result.
What the first visit looks like
We assess foot mobility, calf strength and tenderness at specific points on the tendon, and then go through the last few weeks of your training with you. At the same visit we treat you and hand over the plan: what to change in your running and which exercises to start straight away. Follow-up sessions are for increasing the loads and checking progress – often together with medical training run in the hall next door.