What and Where Are the Tender Points of Fibromyalgia?

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Understanding Fibromyalgia Tender Points
Years ago, I taught a class on the “power of touch.” There was a case study on the healing effect of human contact and touch.

Those who received hugs, light massage and affection experienced a greater reduction of pain as well as a shorter recovery period than those who did not. The physicians conducting the research took the study even further by visiting a burn unit.

While the patients could not tolerate touch, the therapists would simply wave their hands slowly over the body just inches from the patient. It seems that the patient could still “feel” the healing effect of closeness and experienced reduction in pain as well as faster recovery.

As a person who is quite affectionate by nature, I have experienced the healing effects of touch. Sometimes a hug or a soft embrace can melt away stress and pain as no medication can.

When I first began to show symptoms of fibromyalgia though, it was heartbreaking to me to not be able to tolerate touch like I once had. I was a hugger, and it wasn’t fair!

There were days when I even felt as if my hair hurt. I couldn’t stand to blow dry or brush my hair. Hugs or handshakes were like torture on those flare-up days. At night when I laid down, it hurt for my knees or ankles to touch each other, or my hands and arms to touch the mattress.

Of the multiple symptoms and conditions that fibromyalgia brings, the pain of fibromyalgia tender points and trigger points is one of the most difficult to get used to.

What Are Fibromyalgia Tender Points?

Fibromyalgia tender points are areas of pain around joints, but not in the joints themselves. Joint pain would be an indicator of arthritis, but tender points are a sign of fibromyalgia.

These places hurt when you press on them. They are often not deep areas of pain.

Instead, they seem to be just under the surface of the skin. It has been speculated that fibromyalgia is due to sensitivity in the nerves of the body which would explain the surface pain of these tender points.

The place that’s the most tender is usually tiny, about the size of a penny. These spots are much more sensitive than other nearby areas. In fact, pressure on one of the tender points with a finger will cause pain that makes the person flinch or pull back.

Doctors don’t know for certain what causes these pressure points, but they do know that their locations are not random. They happen in predictable places on the body. That means many people with fibromyalgia have similar symptoms with their tender points.

Routine lab tests do not detect the widespread pain of fibromyalgia. Instead, a doctor diagnosis by a physical exam of these pressure points.

Light pressure is applied to the surface of the muscles throughout the body in eighteen (9 pairs) specific tender points or pressure points. Patients with fibromyalgia find this painful, particularly in these specific tender point areas used for diagnosis.

To be diagnosed with fibromyalgia, the patient must experience pain in at least 11 of the eighteen tender points.

Where Are Fibromyalgia Tender Points Located?

If you suffer from fibromyalgia, you might ask, “Where doesn’t it hurt?” on many days.

Still, the specific tender points common to everyone diagnosed with fibromyalgia are scattered over the neck, back, chest, elbows, hips, buttocks, and knees.

  • Back of the neck. If you have fibromyalgia, you may have tender points at the back of the neck, where the base of the skull and the neck meet.
  • Elbows. Fibromyalgia patients may also feel tenderness on their forearms, near the crease of each elbow. The pain tends to be below the crease and toward the outer side of the arm.
  • Front of the neck. In addition to the back of the neck, doctors will check potential fibromyalgia patients for pain at the front of the neck. This pair of trigger points is located well above the collarbone, on either side of the larynx.
  • Hips. Hip pain is common in those with osteoarthritis, but people with arthritis tend to feel it in the joint. In contrast, people with fibromyalgia may have a tender point near where the buttock muscles curve to join the thighs.
  • Lower back. The lower back is one of the most common body parts to be the source of pain. Overall, more than 1 in 4 U.S. adults has experienced low back pain.However, people with fibromyalgia may have pain trigger points at the very top of the buttocks, right at the bottom of the lower back.
  • Knees. While knee trouble is common in people with fibromyalgia, the inside of each knee pad may feel tender to the touch.
  • Upper back. Tender points are often sites on the body where tendons and muscles meet. Such is the case for this pair of tender points, located where the back muscles connect to the shoulder blades in the upper back.
  • Shoulders. In addition to tenderness in the upper back, some people with fibromyalgia have tender points just above that, halfway between the edge of the shoulder and the bottom of the neck.
  • Chest. People with fibromyalgia may have tender points on either side of the sternum, a few inches below the collarbone (near the second rib). The sternum, also known as the breastbone, helps protect the heart and lungs.

Fibromyalgia Tender Points Diagram

What and Where Are the Tender Points of Fibromyalgia?

What Can Make Tender Point Pain Worse?

There are some things which can trigger or make your fibromyalgia symptoms worse. They may include:

  • Anxiety
  • Changes in weather – for example, cold or humidity
  • Depression
  • Fatigue
  • Hormonal changes, such as PMS
  • Infections
  • Lack of sleep or restless sleep
  • Emotional stress
  • Physical exhaustion
  • Not moving around enough

Tender Points vs. Trigger Points

While tender points are small pressure points throughout the body, the widespread pain is the result of what is called “trigger points.”

Trigger points are firm nodules that you can often feel in your tight, rope-like muscles. Pressing on a trigger point hurts in the area and also shoots pain to other regions.

It has been proven that about 90% of the eighteen tender points we mentioned earlier are also myofascial trigger points. This knowledge is a good thing because determining which ones are trigger points will help better determine how to treat the pain.

Treatments and Remedies

There are specific fibromyalgia treatments for relieving the painful knots in the muscles where the trigger points are located, and research shows that relieving the pain of just one trigger point can have a significant effect on reducing your body-wide pain.

One of the more popular approaches is therapeutic massage, which involves working out the trigger points to try to get the muscles to relax. Therapeutic massage can manipulate the muscles and soft tissues of the body to help ease the pain, muscle tension, spasms, and stress.

I experienced the benefits of therapeutic massage during a time when I was in physical therapy. The therapist would do deep heat massage where they could feel these “knots” in my muscles.

It was a challenge each week to try and “work out” these knots and a bit painful. The therapist also provided electrical pulse stimulus massage as well.

Each of these, as well as low-impact exercises with stretch bands, a stationary bike and light weights proved beneficial in working out the pain of these trigger points and knotted muscles.

Other Treatments

In addition to therapeutic massage, there are many ways to manage the pain of tender and trigger points from fibromyalgia. Some treatments are conventional while others are alternative therapies.

The treatment for fibromyalgia and tender points involves a mix of medications, daily stress management, exercise, rest, and water activities called hydrotherapy. If you have not tried hydrotherapy, I recommend you ask your doctor about this alternative therapy.

Alternative therapy is much easier on the muscles and joints and has a relaxing effect. Your doctor can provide a referral to a physical therapy center that has a heated pool for hydrotherapy.

Home Remedies for Tender Point Pain

How you handle fibromyalgia pain at home is another important part of your overall treatment.

For example, try putting moist heat on your muscles twice a day to ease deep muscle pain and stiffness. You can use a moist heating pad or heat “cozy” that you warm in the microwave.

Anything that eases muscle tension, such as a hot shower or soaking in a hot tub, will reduce the impact of the trigger points. Unlike tender points, trigger points cause a restricted range of motion (muscle tightness), and they radiate pain to other areas of the body.

It’s also important to manage your schedule and control your stress levels. Be sure to block out time each day to rest and relax.

Avoid making too many commitments that can wear you out. You can also try relaxation exercises such as guided imagery, deep-breathing exercises, or the relaxation response to manage how you deal with stress.

Also, try to go to bed at the same time every night. It allows your body to rest and repair itself. Get regular exercise. It will help you manage the pain and other symptoms of fibromyalgia.

In Conclusion…

Don’t be afraid of touch! While these tender and trigger points can sometimes seem like conduits of pain, they can also be channels of healing with a soft touch.

Aside from the professional massages and therapies, let loved ones lightly rub your neck or back, softly rub your feet, stroke your head or just tenderly hold you close. I have found that these moments with people I care about melt away stress and reduce pain like nothing else.

Companions and even your children or a friend can share in your care. Let the little ones rub your feet. Ask your partner for a neck rub or a head massage. A little tender loving care goes a long way!


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