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Fibromyalgia Trigger Points and Tender Points

Fibromyalgia Trigger Points and Tender Points

Trigger points and tender points are two terms that have been used interchangeably, in the context of fibromyalgia. However, both are different and are linked to this medical condition in different ways.
Sonia Nair
Last Updated: Apr 26, 2018
Fibromyalgia is a medical condition that is characterized by long-term, widespread pain. Apart from the pain, the symptoms of fibromyalgia include fatigue, sleep disturbances, headaches, and anxiety. Fibromyalgia pain may develop simultaneously in different locations.

Another feature of this medical condition is the presence of tender points. The term 'tender points' is often used interchangeably with 'trigger points', but both are said to be different. While tender points are associated with fibromyalgia, trigger points are mainly related to musculoskeletal disorders. Though it is claimed that trigger points are not at all relevant for fibromyalgia, recent studies suggest the contrary.
What are Fibromyalgia Tender Points
Fibromyalgia Tender Points
As mentioned above, the presence of tender points is a characteristic feature of fibromyalgia. These points can be defined as areas that are exceptionally tender and are sensitive to pressure and touch. The affected people experience intense pain, if a small amount of pressure is applied on these spots.

Though tender points are mostly located near certain bone joints, fibromyalgia does not involve the joints. The area covered by each point, is lesser than the size of a penny. Unlike trigger points that are found to develop in random locations, tender points develop in certain specific sites only. Usually, such locations do not show any sign of inflammation.

There are eighteen tender points, that are located at nine bilateral locations on the body. These points are located on the nape of the neck, on the shoulders, between the shoulder blades, upper hips, below the hips, front side of the neck, upper chest, inner elbows, and the knees.
Location of Tender Points
People having fibromyalgia experience widespread pain, which is felt on both sides of the body. These points are located above and below the waist, and on both the anterior and posterior sides. There are 18 tender points, which are listed as follows. The first four pairs are located on the anterior side of the body, whereas the last five pairs are on the posterior side.
Tender Points on the Anterior Side
Front Neck
The low cervical tender points are located at the anterior aspects of the intertransverse spaces at C5-C7 (lower vertebrae of the neck). In simple words, these points are found on the front side of the neck, one on the right side and the other on the left.
Front Neck
Front Neck
Chest
The next pair of tender points can be found just below the first pair. The exact location is near the insertion of the second rib (upper lateral to the second costochondral junction). In simple terms, these tender points are found on the left and right sides of the chest, below the collarbone.
Chest
Chest
Elbows
The third pair is located on the sides of the elbows. The location is termed as lateral epicondyle, a spot which is two centimeters distal to the epicondyle (side of elbow). To be precise, these tender points are located on the inside of the arms, that corresponds to the elbow.
Elbows
Elbows
Knees
The knees too carry two fibromyalgia tender points, which are found at the medial fat pad proximal to the joint line. Both the knees have one tender point each, on the knee joint.
Knees
Knees
Tender Points on the Posterior Side
Back of the Neck
Two tender points are located on the nape of the neck, near the base of the skull. These occiput tender points are found just below the hairline, on both the left and right sides. In scientific terms, the exact location is given as suboccipital muscle insertions.
Back of the Neck
Back of the Neck
Shoulder
The next pair consists of the trapezius tender points. The exact location is given as the mid point of the upper border of the trapezius muscle. In simple words, the location can be explained as the point where the neck meets the shoulder. There is a left trapezius tender point as well as a right trapezius point.
Shoulder
Shoulder
Upper Back
The third pair of fibromyalgia tender points on the posterior side of the body is situated just below the second pair (trapezius points). The exact location is the supraspinatus muscle, found above the medial border of the scapular spine. In simple words, these tender points are found in between the shoulder blades.
Upper Back
Upper Back
Lower Back
There are two tender points located just below the waist, above the buttocks. The location can be described as the upper outer quadrant of the buttocks. Situated in the gluteal region, these points are called gluteal tender points.
Lower Back
Lower Back
Below the Hips
After the gluteal ones, the next two are located on the greater trochanter - the upper part of thigh, just below the hip muscles.
Below Hips
Below Hips
Tender Points and Fibromyalgia Diagnosis: According to the American College of Rheumatology (ACR), pain and other symptoms can be diagnosed as symptoms of fibromyalgia, if the following conditions are met. (1) The pain must be widespread and should last for at least three months. (2) At least 11 out of the 18 tender points must show symptoms (intense pain), on application of pressure. These two factors are very critical in diagnosing the condition. Among the two, the second point is considered more important. However, it is also claimed that fibromyalgia cannot be ruled out, if these factors are lacking. Another important aspect that is taken into consideration is the possibility of other underlying conditions that may cause the pain. So it is important to rule out such possibility.
What are Fibromyalgia Trigger Points
Trigger points are usually associated with chronic musculoskeletal disorders. Such points may develop in any skeletal muscle. Otherwise known as muscle knots or trigger sites, trigger points are defined as hyper-irritable spots located in taut bands of muscle fibers. A trigger point is often described as a hypersensitive nodule or bundle of muscle fiber, that is abnormally harder than normal muscle fibers. So it is a contraction of a small part of a muscle that remains tight and taut. This causes pain in the muscle as well as the points, where the muscle is attached. So pain in the bones and joints is also commonly associated with trigger points. Muscle weakness and restriction of movement is also caused. Apart from causing local pain and tenderness, trigger points may cause pain in distant locations too. Another feature of trigger points is local twitch response, which is the momentary reaction of the taut muscle, when it is subjected to pressure. Trigger points can be classified into active and latent ones. The active trigger points cause local as well as referred pain, even during rest. The latent trigger points are usually associated with muscle weakness, and sometimes, restriction of movements. Pain is experienced only when the point is subjected to some sort of pressure.
Trigger Points Vs Tender Points
  • Location: While tender points are believed to be located on eighteen specific spots, trigger points may develop in any skeletal muscle. Trigger points could be singular or multiple, whereas tender points are always multiple.
  • Nature: Fibromyalgia tender points are characterized by local tenderness, whereas the features of trigger points include taut muscle fiber and local twitch response, along with tenderness.
  • Pain: This is one of the main differences between fibromyalgia tender points and trigger points. Trigger points can cause local as well as referred pain. The discomfort caused by the tender points are restricted to local area. With multiple tender points, a widespread diffused pain is experienced.
Link Between Trigger Points and Fibromyalgia
Though it is said that tender points and trigger points are totally different, they are linked in certain ways. As mentioned above, tender points are associated with fibromyalgia and trigger points are relevant for musculoskeletal disorders. Some people have both fibromyalgia as well as a musculoskeletal disorder, like myofascial syndrome. In such cases, both tender points and trigger points coexist. So, a musculoskeletal disorder may be misdiagnosed as fibromyalgia and vice versa. According to recent studies, active trigger points could be a contributory factor for fibromyalgia. Mostly, the tender point sites have trigger points too. The pain caused by active trigger points may activate the central sensitization mechanism, which is believed to be the cause of fibromyalgia. It is also claimed that such trigger points may worsen fibromyalgia pain. So a thorough examination is very important to evaluate the underlying condition(s).
Treatment for fibromyalgia is aimed at managing the symptoms and improving the over-all health. Medication, exercise, and cognitive-behavioral therapy, are used for treating this medical condition. Medication include pain killers, antidepressants, etc. Anti-seizure drugs may also be prescribed for some people. Various measures are adopted to improve the fitness levels and to address sleep problems as well as stress. Factors, like anxiety, extreme stress and fatigue, sedentary lifestyle, weather changes, infections, etc., may worsen the symptoms. So make sure to avoid such factors. In short, maintain a healthy lifestyle to control the symptoms of fibromyalgia.
Disclaimer: This article is for informational purposes only and should not be used as a replacement for expert medical advice. Visiting your physician is the safest way to diagnose and treat any health condition.