Tendinitis is scar tissue. The tendon was torn slightly-not torn in half, just some of the fibers broken. One way that tendons tear is overuse in one repetitive motion (anything from tennis to keyboarding). Tendons will also tear from a one-time blow (a fall or car accident). Sometimes both happen at once; while vacuuming, you fatigue the biceps tendon and then you might unexpectedly bump the vacuum into a table leg.

How do you know if you have tendinitis? Only a doctor may diagnose you, but here are some signs and symptoms. Does one particular action cause pain? With tendinitis, refraining from that and similar activities reduces the pain in a week or two, and the pain may go away altogether if you completely stop the activity. Just because the pain is gone does not mean you are cured-the scar tissue is still there. And who wants to go through their whole life avoiding activities?

Imagine a violin bow, made of long parallel horse hairs that are pulled into one thick strand. Imagine this bow frays in the middle, and to repair it, you glue a cotton ball to it. Would you expect this to be a permanent solution? The next time you tried to strum the violin with the bow, the cotton ball would thump across the strings every stroke. Like the bow, tendon fibers are parallel, and like cotton, scar tissue fibers are randomly directed, with a glue substance between. Scar tissue creates a lump. Even though the lump is smaller than a grain of rice, it rubs on other tissues every time you move the joint. That hurts! What's worse, random fiber direction does not have the tensile strength of parallel fibers. Which means, that no matter how long you rest from tendinitis, the next time you give a 100% effort (swinging a racket with full force, or typing for ten hours), that scar tissue will tear again, as bad as the first time.

The solution is to mechanically remove the excess scar tissue.

One theory I learned at the Brian Utting School of Massage comes from The British Dr. James Cyriax. Rubbing the scar tissue perpendicular to the tendon fibers, breaks only those scar fibers that happen to lie perpendicular to the tendon, but only strums those fibers that happen to be parallel. After applying "cross fiber friction" a number of weeks, the remaining unbroken scar tissue lies flat with the tendon. Because those fibers left unbroken are the fibers that lie parallel with the tendon, the scar tissue possesses 100% of the original tendon strength. The textbook treatment includes two minutes of cross-fiber friction as hard as you can stand, tears coming to your eyes. This would be done no more than two or three times a week, followed by ice. I used this method on many people but found they wouldn't continue treatment-it hurts too much. So instead of painful rubbing, I now use an Ice Cup. Since I switched to ice treatment instead, I find many more people continuing their treatment at home.

Ice is like magic!

How To Treat Your Own Tendinitis:

Put water in your freezer now, so it will be ready tomorrow morning. Freeze the water in a little yogurt cup or 6-8 oz. paper cup. Tomorrow, when the ice is ready, pop the ice out of the cup and hold it with a hand towel, to catch the drips. Use not the flat surface, but the edge of the ice to saw perpendicular across the tendon at the exact site of tiny scar tissue lesion. Chill an area no larger than the size of a dime.

Ice yourself no longer than five minutes (watch a clock or set a timer!) or until numbness, whichever comes first. (You may check for numbness by removing the ice, dragging a finger lightly over the area to see if you can still feel it.) If you ice more than five minutes, you will give yourself frostbite-I have done this to myself and believe me, you don't want frostbite. Ice only for five minutes. When the feeling comes back in about five more minutes, you may ice again. You could ice up to six times over one hour while you watch a TV show.

Yes, it must be a cup! An ice bag or gel pack will not work; the cold is spread over too large an area, and the tiny spot that needs it does not get cold enough, the melting water maintains 32 degrees. An ice cup maintains a larger thermal mass the same as your freezer, maybe ten degrees below zero. The edge of the cup applies the cold to a much smaller point. Besides, your whole body will shiver if you chill a large area. You will hardly notice the cold if you only chill the size of a dime. You could even sit in a hot tub or warm bath while you ice the limb.

Ice at least once a day, until your pain is gone and your strength is back to 100%.

How does it work? Ice threatens to freeze the cells to death. The body wants all the cells to live so it sends lots of fresh, warm blood to the area. This flushing effect washes away the scar tissue, so I call it "the erosion effect." Second, blood brings macrophages. Macrophages are very large white blood cells who entirely surround a piece of scar tissue and haul it off to the liver or spleen for processing. A certain percentage of white blood cells are present in all blood, so the more blood you can rush past the scar tissue, the more macrophages will "see" the scar tissue. That is why we chill only the size of a dime, to narrow the focus where all these macrophages will arrive and all this erosion will occur.

How long will it take to be cured? You won't believe the results if you ice at least once per day.

Here is the small print-it may be difficult for you to find the exact spot of the scar tissue lesion. The lump is not always large enough to feel, it could be as small as a grain of salt. Some people can point exactly where the spot is, but most feel it as a shifty, vague location.

If you can't find the exact spot, check out an anatomy book from the library. Likely places for tendinitis pain are:

• front of the shoulder (subscapularis and/or biceps),
• top of the shoulder (supraspinatus),
• back of the shoulder (infraspinatus and/or triceps),
• wrist (extensor digitorum upper attachment near elbow),
• sits bone (hamstrings),
• bottom of foot (inner or outer curve of heel plantar fascia)
• groin (pectineus)
• front of hip (psoas or Tensor Fascia Latte)
• knee (just above or below patella)

While looking at the anatomy book pictures, realize that the most likely places for tendinitis are 1) where the tendon attaches to the bone, and 2) where the reddish muscle turns into the yellowish tendon. One hurdle is, that you feel pain "distal," or farther from the brain, than the real injury. If all you have is a vague sense of the location, try poking the nearest tendon and following it "upstream" until you find the pain source. In almost all cases, people don't realize there is one tiny painful spot until we begin poking the tendons.

How do you know you've found it?

"OW, that's IT, you're exactly ON it!"

Even when you think you are right on it, move around in very small increments in each direction, playing a game of "warmer, colder" to zero-in on the maximum pain spot. This is the scar tissue lesion you will ice for five minutes.

If you can't find it yourself, search around for a therapist who knows anatomy well. Unfortunately, only a small percent of therapists and Doctors were ever trained to palpate where tendons join with bones and muscles. Call a few and ask them if they can help you find the exact location of a tendinitis lesion. Go at least once and bring a permanent marker so they can put a dot over the lesion. This way you can find it again when you get home, to do your daily home icing. If the pain is somewhere you can't reach, like the back of your shoulder, this dot will help your spouse or friend to ice you daily at home.

This article is not intended to provide you with a diagnosis-only a doctor can diagnose you. That said, no harm will come to you from icing parts of your body, so give it a try! Sometimes a person who has been diagnosed with "carpal tunnel syndrome" feels relief after icing the flexor and extensor tendons at the elbow. In every case of "plantar fascitis" that I have seen, the person improved when we addressed scar tissue lesions on the bottom of the heel.

The purpose of pain is to help you learn to do something differently. How did this scar tissue occur in the first place? Icing the lesion will make it go away, but you still need to change something about the way you do this activity, so you don't create a new lesion.

My sincere intention is that you are empowered to heal yourself of this long-nagging pain, and that you make changes for a happier future. Happy Frosting!