What Are Fibromyalgia Tender Points?

Fibromyalgia isn’t a simple condition to diagnose. There are no laboratory tests that can detect it, so it’s up to your doctor to recognize the symptoms and exclude other conditions.

One way that doctors try to narrow down a diagnosis of fibromyalgia is by exerting pressure on 18 small spots located throughout the body. These spots are known as tender points.

Tender points are usually present in people with fibromyalgia. In 1990, the American College of Rheumatology identified 18 specific spots that are often, but not always, tender in people with fibromyalgia. These spots became part of a diagnostic test. Prior to 2010, at least 11 of these 18 points had to test positive for tenderness for your doctor to officially diagnose you with fibromyalgia. The diagnostic criteria for fibromyalgia has since changed. However, tender point examinations are still a common diagnostic tool.

Diagnosing fibromyalgia with tender points

There are 18 tender points throughout the body, each about the size of a penny. Fibromyalgia tender points are located in clusters around the neck, chest, shoulders, elbows, hips, and knees. They’re located on both sides of the body, both above and below the waist. For a point to be considered tender, the spot should produce localized pain when your doctor presses on it with their finger. The doctor will push with enough pressure that their fingernail turns white. A point that tests positive for tenderness will be painful only on the exact spot the doctor presses.

One of the defining characteristics of fibromyalgia is that the pain usually fluctuates. It may come and go, move around, or vary widely in intensity from day to day. On the day that you call your doctor to make an appointment, you might have tenderness in all 18 tender points. On the day of the appointment itself, you may only have tenderness in four of them. Over the years, many people with fibromyalgia have gone undiagnosed because they didn’t have tenderness in 11 spots at the time of their physical exam.

A tender point test is still a helpful guidepost for physicians. But expanding the diagnostic criteria has helped more people get the right diagnosis. Once you’re diagnosed with fibromyalgia, you’ll be able to understand the cause of your pain. You can then work with your doctor to improve your symptoms.

Tips for coping with tender points

People with fibromyalgia are typically more concerned about full-body aches and general tenderness than specific tender spots. If you have fibromyalgia, you probably think most about the symptoms that interfere with your daily life. These may include:

  • morning stiffness
  • difficulty moving
  • pain during handshakes and hugs
  • painful knots in your muscles

Painful knots in your muscles are often myofascial trigger points. Trigger points are hard, knotty lumps that form in taut skeletal muscles. Unlike tender points, which produce only localized pain, trigger points produce both localized and referred pain. Referred pain feels like it shoots or radiates to a different part of your body. Trigger points are far more common in people with fibromyalgia than they are among the general population. However, anyone can develop them.

There’s a chronic widespread pain condition called myofascial pain syndrome. It involves chronic trigger point pain. Myofascial pain syndrome can coexist with fibromyalgia. A study in The Journal of Pain, the official journal of The American Pain Society, found that most tender points are also myofascial trigger points.

Additionally, a study published in the journal Pain discovered that much of the neck and shoulder pain that people with fibromyalgia experience is caused by trigger points, not tender points. This is good news, because there are several treatments for trigger point pain that you can start right away.

Trigger point injections for fibromyalgia

Trigger point injections can deactivate a painful trigger point, providing pain relief in certain areas. Trigger point injections should be given by a trained pain specialist with specialized equipment. Injections can contain saline, steroids, or a local anesthetic like lidocaine.

Ask your doctor if they administer trigger point injections or know of another doctor who does. Or visit the American Board of Pain Medicine’s directory of certified pain specialists to find someone in your area who administers trigger point injections.

Acupuncture treatment for fibromyalgia

There are many similarities between fibromyalgia tender points, myofascial trigger points, and acupuncture points. Acupuncture, the ancient Chinese practice of inserting needles into specific points on the body, has been used to relieve pain for thousands of years.

If you haven’t tried acupuncture yet, it may be an excellent treatment option. Most acupuncture clinics can quickly fit you in for an appointment. You can check out the Acufinder directory of acupuncturists to find a traditional practitioner in your area. If you’re interested in seeing a doctor who practices acupuncture, you can check out the American Academy of Medical Acupuncture’s online directory.

Trigger point massage therapy for fibromyalgia

A study in the Journal of Manipulative and Physiological Therapeutics suggested that two types of massage therapy significantly help women with fibromyalgia.

Manual lymph drainage therapy is a massage technique that moves fluid away from areas where lymph vessels are blocked or damaged. Connective tissue massage is an intense massage technique that focuses on manipulating myofascial tissue. Researchers suggest that both techniques lessen pain, improve quality of life, and increase pain thresholds.

Not all massages are created equal, so don’t expect the best results from your local spa. You might want to start by asking for recommendations from friends, your family physician, or your fibromyalgia specialist.

For more help finding a qualified massage therapist near you, also check out the American Massage Therapy Association’s directory of certified practitioners.


Fibromyalgia tender points are areas where you may experience localized pain when they’re pressed. Trigger points cause localized and radiating pain. In order to experience relief from pain associated with both, talk to your doctor about potential therapies that may help.


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