An Achilles tendon that hurts every morning and flares after every run is a tendon that has fallen behind its load. Dr. Cisneros rebuilds it in the order the evidence supports — isometrics to settle it, eccentrics to rebuild it, heavy slow loading to make it strong — with dry needling of the calf in support, one-on-one for the full hour every visit.
Achilles tendinopathy is a tendon that has fallen behind the load you ask of it. Where it hurts and how it behaves under load decide the program.
First steps out of bed are the worst, the tendon loosens as you move, and it is back the next morning. The classic mid-portion presentation, and the one that responds best to loading.
Pain that came on with a jump in mileage, hills, speed work, or a shoe change, and warms up during the run only to flare afterward. A dosing problem: the tendon needs load, just not that much that fast.
Insertional tendinopathy: pain where the tendon meets the heel, worse with stretching and with uphill walking. Loads only to floor level and avoids the stretching that makes it worse.
A visible or palpable thickening a few centimetres above the heel that has been there for months. The tendon has remodelled; the program is heavier and slower, and it still works.
CrossFit, basketball, volleyball, Olympic lifting: high-volume plyometrics and heavy calf load. Rehab has to end in heavy loading and jumping, or it did not finish.
A sudden pop, a feeling of being kicked in the calf, or inability to push off is a possible Achilles rupture and needs same-day medical assessment, not a rehab program. Dr. Cisneros will tell you if that is what he sees.
Each starts with a diagnosis of which part of the tendon is overloaded and why, then a loading program staged to what it will tolerate today. Dry needling and manual therapy support that plan; they are not the plan.
Tendons rebuild under progressive load and nothing else. The order matters: settle the tendon, rebuild it, then make it strong enough to run and jump on. Dr. Cisneros sets each load from your evaluation and progresses it on how the tendon responds, not on the week number.
Heavy, held calf contractions with no movement — typically five holds of around 45 seconds, several times a day, at a load that is hard but does not provoke the pain. Isometrics reduce tendon pain rather than aggravate it and keep the calf from switching off. One to two weeks, and the tendon has earned the next phase.
Slow heel drops: up on both legs, down on the painful side over three seconds — off a step for mid-portion tendinopathy, only to floor level for insertional. Heavy and consistent for several weeks. This is the loading with the longest track record for Achilles pain, and it is where the tendon starts to rebuild capacity instead of just calming down.
Full calf raises up and down, three seconds each way, with real weight — barbell, leg press, or Smith machine — progressed every week or two. Heavy concentric-eccentric loading builds the tendon stiffness and calf strength that running and jumping demand. Skipping this phase is why Achilles pain returns in the first hard week back.
Hops, skips, bounding, and sport-specific plyometrics reintroduced on a schedule the tendon tolerates, alongside a graded return to running volume, hills, and speed. Dry needling of the gastrocnemius and soleus and ankle mobilization run alongside every phase to keep the loading tolerable.
A tendon that has been overloaded stiffens when it rests, so the first steps and the first minutes of a run load it before it has warmed up. Pain that eases as you go and returns the next morning is the signature of Achilles tendinopathy. It is a tendon that has fallen behind the load you ask of it, not a tear and not inflammation in the old sense — which is why rest alone brings it back the day you restart.
Because a painful tendon will not tolerate movement-based loading yet, and an isometric — a heavy, held calf contraction with no movement — loads the tendon while reducing pain rather than provoking it. Five holds of about 45 seconds at a heavy but tolerable load, several times a day in the first one to two weeks, settle the tendon, keep the calf from switching off, and earn the right to progress. Dr. Cisneros sets the load from your evaluation rather than starting at bodyweight and hoping.
Slow lowering: heel raises where you go up on both legs and come down on the painful side over three seconds, off a step for mid-portion tendinopathy and only to floor level for an insertional one. This is the Alfredson-style loading with the strongest track record for Achilles pain. It is done heavy and consistently — daily or every other day for several weeks — and it is where the tendon starts to rebuild its capacity rather than just calm down.
Once eccentrics are tolerated with the pain settling within 24 hours, the program moves to heavy slow resistance: full calf raises, up and down, three seconds each way, with real weight — a loaded barbell, a leg press, or a Smith machine — progressed every week or two. Heavy concentric-eccentric loading builds the tendon stiffness and calf strength that let you run and jump again. Skipping this phase is the most common reason Achilles pain returns the first hard week back.
Tendons adapt slowly. Pain typically settles in the first few weeks of isometrics and eccentrics, but the tendon itself needs 12 weeks or more of progressive loading to rebuild, and a long-standing case needs longer. Feeling better at week four is the halfway mark, not the finish. Dr. Cisneros will map the phases against your calendar at the evaluation so the return to running is planned, not guessed.
It matters for the loading. Mid-portion pain sits two to six centimetres above the heel bone and tolerates loading through a full range, including heel drops off a step. Insertional pain sits right where the tendon meets the heel and is aggravated by stretching and by dropping the heel below the step — so those cases load only to floor level and avoid aggressive calf stretching. Treating an insertional tendon with a mid-portion program is a common reason people get worse.
It helps the muscle, not the tendon directly. Tight, guarded gastrocnemius and soleus keep constant tension on the Achilles; needling those trigger points, including with electrical stimulation, reduces that pull and the pain so the loading program can be done properly. Dr. Cisneros uses it in support of the isometric-to-eccentric-to-heavy progression, never instead of it.
Usually yes, at a controlled dose. The rule is that pain during and after running should stay mild and settle within 24 hours; if the next morning is worse, the dose was too high. Complete rest deconditions the tendon and makes the restart harder. Dr. Cisneros sets a running volume the tendon tolerates, cuts hills and speed work early, and builds them back as the loading phases progress.
For mid-portion tendinopathy, gentle calf stretching is fine and sometimes helpful. For insertional tendinopathy, aggressive stretching compresses the tendon against the heel bone and aggravates it — that is the case where stretching is the problem, not the cure. Loading builds tendon capacity; stretching does not, which is why the program is built on isometrics, eccentrics, and heavy slow resistance rather than on stretching.
No. Texas is a direct access state — you can see a licensed physical therapist for Achilles tendinopathy without a doctor's referral. At Solas PT in El Paso you can start without a referral or prior authorization; Texas direct access covers the first 30 consecutive calendar days, and a referral is needed to continue past that. Because tendon rehab runs 12 weeks or more, Dr. Cisneros plans that referral with you early rather than at day 29.
Solas Physical Therapy is a top-rated choice for Achilles tendinopathy in El Paso, holding a 5.0-star rating across 36 Google reviews. Dr. Andrew Cisneros, PT, DPT, MS builds the loading progression the evidence supports — isometrics to settle the tendon, eccentric heel drops to rebuild it, then heavy slow concentric loading to make it strong enough to run and jump on — with dry needling of the calf in support, and a strength-and-conditioning background that shows in how the loads are actually set. Every session is a full hour one-on-one. Solas PT is cash-based and direct-access at 300 N Resler Dr, Ste F in west El Paso.
Same-week appointments available. No referral needed. One-on-one with Dr. Cisneros every session.
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