Do You Have Tender Points?

If you're struggling with chronic pain, the first step to getting help is getting the right diagnosis. For millions of people, the exact locations where they feel pain help doctors define their diagnosis. Tender points are the telltale sign that often leads to a Fibromyalgia diagnosis. But what are tender points and how do you know if you have them?

Tender points are localized areas of pain. They're located right under the skin, near, but not directly in joints and bones. They hurt when you push on them. Tender points are located throughout the musculoskeletal system but a fibromyalgia diagnosis is made when 11 out of 18 specific points are painful. While patients with fibromyalgia often say, "I hurt all over," tender points actually affect small areas of a muscle rather than the whole muscle. 

How do these tender points relate to fibromyalgia? Fibromyalgia is a syndrome characterized by widespread muscle pain, fatigue, depression and tender points. The American College of Rheumatology (ACR) specifies two major criteria for diagnosing fibromyalgia:

1. Three or more months of widespread pain defined as pain present above and below the waist on the right and left side of the body and along the midline

2. Report of pain at a minimum of 11/18 specified locations (tender points) throughout the body when palpated with 4 kilograms of digital pressure.

What Causes Tender Points?

Doctors and scientists aren't sure yet what causes tender points to hurt. Some theories suggest the pain is due to inflammation and other theories say nerves in these areas are over sensitive. Pain may be triggered by lack of sleep, stress, viruses, hormonal changes, weather changes, anxiety, depression, exhaustion and other factors that tax the body. 

Where are the Tender Points Located?

Tender points are located in nine areas on both sides of the body:

1. Occiput - neck muscles at the base of the skull

2. Low Cervical - front of the neck midway between the neck and shoulder

3. Trapezius -over the upper inner shoulder blade

4. Supraspinatus - above the shoulder blade

5.  Second Rib - upper edge of breast bone, below collar bone

6. Epicondyle - just below the elbow

7. Gluteal - upper outer area of the buttocks

8. Greater Trochanter - lower outer area of the buttocks

9. Knee - inside edge, above the knee

Most patients experience pain bilaterally. They may not feel pain in all nine spots and pain may not be limited to just these spots. 

If you think you have tender points, they've lasted more than three months and you also have other symptoms of fibromyalgia, see your family physician or a rheumatologist. There's no cure for fibromyalgia, but there are many treatment options available to make symptoms manageable. 


National Fibromyalgia Research Foundation

ACR Fibromyalgia Diagnostic Criteria