Fibromyalgia Tender Points

By Dr. Edward F. Group III, DC, ND, DACBN
updated on 06/20/2007 at 11:06AM

Fibromyalgia is a chronic condition that affects roughly six million Americans each year. The condition is characterized by widespread pain and stiffness throughout the body, as well as pain in at least eleven of each of the eighteen tender points on the body. These tender places occur symmetrically on both sides of the body.

Where Are The Tender Points Located?

Tender points occur in pairs throughout the body. Two tender points are located at each of the following locations:

On your back, there are tender points:

Along the spine in the neck, where the head and neck meet on the upper line of the shoulder, a little less than halfway from the shoulder to the neck three finger widths, on a diagonal, inward from the last points
On the back fairly close to the "dimples" above the buttocks, a little less than halfway in toward the spine
Below the buttocks, very close to the outside edge of the thigh, about three finger widths

On the front of your body, tender points are present in the following places:

On the neck, just above inner edge of the collarbone
Still on the neck, a little further out from the last points, about four finger widths down
On the inner (palm) side of the lower arm, about three finger widths below the elbow crease
On the inner side of the knee, in the "fat pad"
On the hip bones

In order to meet the formal requirements of a fibromyalgia diagnosis, your health care provider must note pain in at least eleven of these points with a minimal amount of pressure. The level of pressure is defined as four kilograms, which is just enough to turn a fingernail white. However, what is painful and tender for one person may not be painful for another. Therefore, many doctors will diagnose a condition as fibromyalgia even if there are less than eleven tender points as long as the patient meets the other criteria for the condition.

When To See A Doctor

If you think you may be suffering from fibromyalgia, you should see your health care provider to have your condition evaluated. Many of the symptoms of fibromyalgia mimic those of other diseases, such as low thyroid hormone production (hypothyroidism), polymyalgia rheumatica, neuropathies, lupus, multiple sclerosis and rheumatoid arthritis. Your doctor can test you for each of these conditions to help you determine the true cause of your symptoms.

Unfortunately, it can be difficult to diagnose fibromyalgia because there isn't a single, specific diagnostic laboratory test to test for the condition. It is more likely that you will undergo a series of medical tests such as blood tests and X-rays to rule out the possibility of other conditions.

Here is the official definition of fibromyalgia as designated by the American College of Rheumatology (ACR) in 1990*

(1) History of widespread pain:

Definition: Pain is considered widespread when all of the following are present: pain in the left side of the body, pain in the right side of the body, pain above the waist, and pain below the waist. In addition, axial skeletal pain (cervical spine or anterior chest or thoracic spine or low back) must be present. In this definition, shoulder and buttock pain is considered as pain for each involved side. "Low back" pain is considered lower segment pain.

(2) Pain in 11 of 18 tender point sites on digital palpation:

Digital palpation should be performed with an approximate force of 4kg. For a tender point to be considered "positive”, the subject must state that the palpation was painful. "Tender" is not to be considered "painful".

Note: For classification purposes, patients will be said to have fibromyalgia if both criteria are satisfied. Widespread pain must have been present for at least 3 months. The presence of a second clinical disorder does not exclude the diagnosis of fibromyalgia.

* from Frederick Wolfe et al, "The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia: Report of the Multicenter Criteria Committee," Arthritis and Rheumatism, Vol. 33, No.2 (February 1990) ,p. 171.

The official definition further requires that tender points must be present in all four quadrants of the body -- that is, the upper right and left and lower right and left parts of your body. Therefore, the patient must not only experience pain, but the pain must be all over the body.

Other treatment methods that might be helpful at alleviating the pain of tender points include dietary changes and low-impact exercise. A topical pain relief product can be found at www.ghchealth.com

With Fibromyalgia, digestive disorders such as constipation or irritable bowel syndrome may occur. The best way to treat these conditions is with a product called Oxy-Powder available at www.oxypowder.com

Anxiety and depression may also occur with fibromyalgia. Help is available at www.stress-anxiety-depression.org

DISCLAIMER: The statements enclosed herein have not been evaluated by the Food and Drug Administration. The products and information mentioned on this site are not intended to diagnose, treat, cure, or prevent any disease. Information and statements made are for education purposes only and are not intended to replace the advice of your treating doctor. Global Healing Center does not dispense medical advice, prescribe, or diagnose illness. We design and recommend individual nutritional programs and supplements that allow the body to rebuild and heal itself naturally. The views and nutritional advice expressed by www.fibromyalgia-support.org are not intended to be a substitute for conventional medical service. If you have a severe medical condition, see your physician of choice. This web site contains links to web sites operated by other parties. Such links are provided for your convenience and reference only. We are not responsible for the content or products of any linked site or any link contained in a linked site.