Fibromyalgia Tender Points Explained: Mapping the Pain & Finding Relief

Table of contents

Fibromyalgia Tender Points Explained: Mapping the Pain & Finding Relief

Understanding fibromyalgia is synonymous with acknowledging the hypersensitivity of specific tender points, which are far more than just areas of pain. A mere light press can cause these points to react with significant sensitivity.

This article aims to guide you through the process of pinpointing these 18 tender points and to shed light on their role in the discomfort experienced due to fibromyalgia pain.

Armed with this knowledge, we'll provide you with techniques to identify, manage, and alleviate this pain, and discuss various treatment methods to improve your coping mechanisms for fibromyalgia.

What are fibromyalgia tender points?

Fibromyalgia tender points are localized areas on the body that react with intense pain to even slight pressure. These points are not associated with joint inflammation but are found in the soft tissue outside the joints. Their heightened sensitivity to touch makes them key contributors to the muscle pain experienced by individuals living with fibromyalgia.

Where are these tender points on the body?

There are 18 tender points that exists as nine symmetrical pairs (left and right), located at the:

  • back of the neck
  • front of the neck
  • upper back
  • lower back
  • shoulders
  • chest
  • hips
  • elbows
  • knees.
An illustration of the front and back of a person, with red spots showing the locations of the tender points, as detailed in the list above.
The 18 tender points.

Are there fibromyalgia pain points in the hands?

Fibromyalgia hand pain can make simple things like writing, using your phone, or grabbing a cup feel like a challenge, and it’s a common symptom. However, fibro pain in your hands isn't coming from those tender points fibromyalgia is famous for, because the hands don't have any of those particular points.

Are there tender points associated with fibromyalgia in the feet?

Living with fibromyalgia can bring about foot pain, but – as with the hands – it’s not because of tender points because there aren’t any recognized tender points in the feet. The pain is real though, and a solid pair of supportive shoes can really help your feet feel a whole lot better. Take a look at our other recommendations for fibromyalgia foot pain too.

Fibromyalgia tender points in ribs

The upper chest, where your collarbones are, has a tender point on each side. In addition, the area around your rib cage has a bunch of other sensitive spots, particularly where your rib meets the cartilage by your sternum (the breastbone, front and center of your chest). These spots can be really tender and might cause discomfort that spreads to your shoulders and arms.

Chest pain can be a serious business, so always get it checked out by a health professional first.

Once you know that your heart and lungs are healthy, you can find ways to ease the discomfort caused by fibromyalgia rib and chest pain. For example, by trying some gentle exercises, such as isometric holds or “ribcage arms” from Pilates. These exercises focus on engaging your muscles in a static way, offering a gentle form of exercise that can help soothe symptoms without exacerbating fibromyalgia pain.

Diagnosing fibromyalgia with tender points

When you're trying to figure out this whole chronic pain puzzle, fibromyalgia is like the piece that only fits after you've made sure all the other pieces aren't the right ones.

Imagine your body as a pain map, fibromyalgia is when the whole map lights up. Checking yourself for fibromyalgia tender points is a good first step, but it's not the whole picture. Your doctor will also want to know about other symptoms that you experience, such as always feeling tired, being unable to sleep well, or struggling to think straight. And it's not just for a day or two; it's a grind for at least three months straight.

Fibromyalgia tender points self-test

If you want to check your tender points, gently press on the various body parts highlighted above. If these areas feel unusually sore, it could be a sign of fibromyalgia tender points.

Keep in mind that this self-check is just a preliminary step. It's not definitive. Self-testing is no substitute for professional medical advice. So, rather than just self-diagnosing through touch, it's crucial to consult with a healthcare provider for a comprehensive evaluation and to discuss effective treatment options.

Why are tender points no longer counted today?

Fibromyalgia used to be diagnosed by checking for pain in the various tender points. However, that method is hit and miss because it’s hard to standardize the pressure or type of touch applied. This means that different doctors get different results, and some cases of fibromyalgia can slip through the cracks.

Recognizing these issues, the American College of Rheumatology decided it was time for a change in 2019. They rolled out new guidelines that take a broader look at fibromyalgia, beyond just those tender spots, to better capture the full scope of what patients go through1. This includes widespread pain, along with other symptoms such as fatigue, tummy troubles, mood disturbances, brain fog and any of the other many varied fibromyalgia symptoms that people can experience.

What can make tender pain points worse?

There are a few things that can turn up the pain on those tender spots if you have fibromyalgia. Knowing what these triggers are can really help you keep the discomfort in check and make your days a bit brighter.

  • Physical and emotional stress: If you're overworked, get injured, or if you're feeling anxious or down, your muscles might tense up, making the pain worse2.
  • Sleep quality: Bad sleep can dial up how much pain you feel. Getting good rest can make a big difference3.
  • Weather changes: Some studies suggest that when it gets cold and damp, or when the air pressure changes, it might make your symptoms stronger. More research is needed, but it's something to watch out for4.
  • Hormonal fluctuations: Changes in hormone levels, particularly for people during their menstrual cycle, pregnancy, or menopause, can ramp up fibromyalgia symptoms5,8,9.
  • Diet and nutrition: Eating foods that are high in sugar or caffeine, or that are heavily processed, might set off more pain.
  • Exercise: Not moving enough can actually make the pain stick around, but doing the right kind of exercise can help you get stronger, more flexible, and manage stress better. It's all about finding that sweet spot where you're active without overdoing it.

Treating fibromyalgia tender points

Addressing fibromyalgia's tender points involves a comprehensive strategy that tackles both the mental and physical facets of the disorder.

The gold standard is the biopsychosocial model – a multidisciplinary approach that uses a blend of therapeutic interventions, lifestyle modifications, pharmaceuticals and complementary treatments that both manages symptoms and enhances life quality for those impacted.

Retraining your pain response

Retraining your pain is a bit like training a puppy – it takes patience, understanding, and a bit of know-how. Pain isn't just a physical thing; it's also about what's going on in your life, your thoughts, and your social scene.

Get to know what sets off your pain – is it stress, something you believe, or maybe a habit? Once you've got a handle on that, you can start tweaking things. This could mean changing up your diet, getting better sleep, moving more, or using brain-training techniques to help your brain and central nervous system to deal with stimuli differently.

With a bit of time and effort, you can teach your brain to handle things in a new way, which can mean less ouch and more living your life.

Here are a few things to try.

Stress management

Stress hormones, such as cortisol, can amplify the body's perception of pain, making any discomfort feel much worse. Completely avoiding stress might be impossible, but there are several strategies to help manage stress levels and mitigate your body's response to stress.

Techniques such as cognitive behavior therapy (CBT), mindfulness meditation, relaxation exercises, and seeking emotional and social support from friends, therapists, or support groups can be beneficial.

Movement & exercise

Engaging in movement and exercise can alleviate pain, elevate your spirits and energy, and enhance the quality of your sleep. It's possible to customize physical activity to accommodate your symptoms and limitations, and it doesn't necessarily need to be structured exercise! Any form of active pastime is beneficial, such as yoga, dancing, or gardening.

Our primary pieces of advice are to take it easy at the start and practice self-compassion. Initiating your exercise journey with gentle, low-impact activities and progressively building up the intensity and length helps your body adjust without undue stress. Being compassionate with yourself aids in facing challenges with determination and positivity.

Sleep quality

Sleep is very important when you're dealing with fibromyalgia – it's a big piece of the puzzle for keeping pain at bay. There's this tricky cycle where a bad night's sleep can make your symptoms worse, and then those symptoms make it hard to get good sleep. It's like they're tag-teaming against you.

We know that getting a good night's sleep can feel next to impossible, but try these tips to help keep those fibromyalgia symptoms in check:

  • Stick to a regular sleep schedule. Try to hit the hay and wake up at the same times every day, aiming for about eight hours of shut-eye.
  • Keep naps short and sweet. If you need to sleep during the day, stick to a quick power nap because if you snooze for too long, it can interfere with your sleep at night.
  • Get moving during the day. Some exercise can actually help you fall asleep faster when bedtime rolls around.
  • Ease up on the screen time before bed. The glow from your phone or laptop isn't doing you any favors when it's time to wind down.
  • Make your bedroom a sleep sanctuary. Keep it dark and quiet to help you stay asleep through the night.
  • Watch the afternoon coffee runs. Caffeine can hang around in your system for many hours and make it tough to fall asleep later.
  • Skip the big meals and booze right before bed. They can throw off your sleep quality.
  • Don't just think about sleep – consider other ways to rest and recharge your body and mind. It all adds up to better handling of fibromyalgia symptoms.

Trigger point injections for fibromyalgia

Do you get those tiny, tight lumps that you can feel right under your skin? They can impact the nerves around them, making you hurt in places far from the actual muscle knot.

Trigger point injections are an option that some people find useful to target those muscle knots that just won't relax. Although more research is needed to confirm just how helpful these injections are.

Acupuncture treatment

Acupuncture is a Chinese traditional treatment in which tiny needles are inserted into problem areas in the body. This treatment can help to dial down pain and improve sleep in some people7, although not everyone, so chat to your healthcare team to find the best solutions for you.

Trigger point massage therapy for fibromyalgia

Trigger point massage can help relax sore muscles, especially if they are tight from too much activity or certain injuries. If you want to try massage, make sure the massage therapist understands what fibromyalgia is all about, so they can give you a massage that's comforting, not painful.

And because everyone's body responds differently, talk with your massage therapist to customize the massage to what works best for you.

Medication

Medication is one piece of your treatment puzzle, but it's not the whole solution. The best approach uses medication as a helping hand, so you can engage in other helpful strategies, such as retraining your brain and tweaking your daily habits.

Lots of different medicines can be used for the symptoms of fibromyalgia, including:

  • everyday painkillers such as aspirin and ibuprofen that you can grab from any pharmacy
  • antidepressants, for example, amitriptyline or duloxetine – they're not just for your mood, they can also take the edge off the pain
  • Low Dose Naltrexone (LDN), which can shake up the way your body feels pain and inflammation
  • anti-seizure drugs such as pregabalin and gabapentin, which can calm down jumpy nerves.

Remember, your doctor is the go-to person for your medications and all other treatments. Always speak to them about what is best for you, before you start trying something new.

More information & support

For more information and support, fill out our suitability survey or get in touch. We can help you to work towards reducing pain severity, flare-up frequency, and emotional distress.

  1. Galvez-Sánchez CM, Reyes Del Paso GA. Diagnostic Criteria for Fibromyalgia: Critical Review and Future Perspectives. J Clin Med. 2020 Apr 23;9(4):1219. doi: 10.3390/jcm9041219. PMID: 32340369; PMCID: PMC7230253. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7230253/
  2. Bhargava J, Hurley JA. Fibromyalgia. [Updated 2023 Jun 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. https://www.ncbi.nlm.nih.gov/books/NBK540974/
  3. Choy EH. The role of sleep in pain and fibromyalgia. Nat Rev Rheumatol. 2015 Sep;11(9):513-20. doi: 10.1038/nrrheum.2015.56. Epub 2015 Apr 28. PMID: 25907704. https://www.nature.com/articles/nrrheum.2015.56
  4. Smedslund G, Eide H, Kristjansdottir ÓB, Nes AA, Sexton H, Fors EA. Do weather changes influence pain levels in women with fibromyalgia, and can psychosocial variables moderate these influences? Int J Biometeorol. 2014 Sep;58(7):1451-7. doi: 10.1007/s00484-013-0747-7. Epub 2013 Oct 17. PMID: 24132549. https://pubmed.ncbi.nlm.nih.gov/24132549
  5. Genç H, Atasever M, Duyur Çakit B, Seval M, Koç A. The Effects of Fibromyalgia Syndrome on Physical Function and Psychological Status of Pregnant Females. Arch Rheumatol. 2017 Jan 5;32(2):129-140. doi: 10.5606/ArchRheumatol.2017.6028. PMID: 30375568; PMCID: PMC6190985. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6190985/
  6. Neelapala YVR, Mercuri D, Macedo L, Hanna S, Kobsar D, Carlesso L. Mechanisms hypothesized for pain-relieving effects of exercise in fibromyalgia: a scoping review. Ther Adv Musculoskelet Dis. 2023 Jul 16;15:1759720X231182894. doi: 10.1177/1759720X231182894. PMID: 37484924; PMCID: PMC10356998. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10356998/
  7. Berger AA, Liu Y, Nguyen J, Spraggins R, Reed DS, Lee C, Hasoon J, Kaye AD. Efficacy of acupuncture in the treatment of fibromyalgia. Orthop Rev (Pavia). 2021 Jun 22;13(2):25085. doi: 10.52965/001c.25085. PMID: 34745475; PMCID: PMC8567806. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8567806/
  8. Alonso C, Loevinger BL, Muller D, Coe CL. Menstrual cycle influences on pain and emotion in women with fibromyalgia. J Psychosom Res. 2004 Nov;57(5):451-8. doi: 10.1016/j.jpsychores.2004.05.003. PMID: 15581648. https://pubmed.ncbi.nlm.nih.gov/15581648/
  9. Dias RCA, Kulak Junior J, Ferreira da Costa EH, Nisihara RM. Fibromyalgia, sleep disturbance and menopause: Is there a relationship? A literature review. Int J Rheum Dis. 2019 Nov;22(11):1961-1971. doi: 10.1111/1756-185X.13713. Epub 2019 Oct 14. PMID: 31612618.https://pubmed.ncbi.nlm.nih.gov/31612618/

Fibromyalgia Tender Points Explained: Mapping the Pain & Finding Relief

Table of contents

Fibromyalgia Tender Points Explained: Mapping the Pain & Finding Relief

Understanding fibromyalgia is synonymous with acknowledging the hypersensitivity of specific tender points, which are far more than just areas of pain. A mere light press can cause these points to react with significant sensitivity.

This article aims to guide you through the process of pinpointing these 18 tender points and to shed light on their role in the discomfort experienced due to fibromyalgia pain.

Armed with this knowledge, we'll provide you with techniques to identify, manage, and alleviate this pain, and discuss various treatment methods to improve your coping mechanisms for fibromyalgia.

What are fibromyalgia tender points?

Fibromyalgia tender points are localized areas on the body that react with intense pain to even slight pressure. These points are not associated with joint inflammation but are found in the soft tissue outside the joints. Their heightened sensitivity to touch makes them key contributors to the muscle pain experienced by individuals living with fibromyalgia.

Where are these tender points on the body?

There are 18 tender points that exists as nine symmetrical pairs (left and right), located at the:

  • back of the neck
  • front of the neck
  • upper back
  • lower back
  • shoulders
  • chest
  • hips
  • elbows
  • knees.
An illustration of the front and back of a person, with red spots showing the locations of the tender points, as detailed in the list above.
The 18 tender points.

Are there fibromyalgia pain points in the hands?

Fibromyalgia hand pain can make simple things like writing, using your phone, or grabbing a cup feel like a challenge, and it’s a common symptom. However, fibro pain in your hands isn't coming from those tender points fibromyalgia is famous for, because the hands don't have any of those particular points.

Are there tender points associated with fibromyalgia in the feet?

Living with fibromyalgia can bring about foot pain, but – as with the hands – it’s not because of tender points because there aren’t any recognized tender points in the feet. The pain is real though, and a solid pair of supportive shoes can really help your feet feel a whole lot better. Take a look at our other recommendations for fibromyalgia foot pain too.

Fibromyalgia tender points in ribs

The upper chest, where your collarbones are, has a tender point on each side. In addition, the area around your rib cage has a bunch of other sensitive spots, particularly where your rib meets the cartilage by your sternum (the breastbone, front and center of your chest). These spots can be really tender and might cause discomfort that spreads to your shoulders and arms.

Chest pain can be a serious business, so always get it checked out by a health professional first.

Once you know that your heart and lungs are healthy, you can find ways to ease the discomfort caused by fibromyalgia rib and chest pain. For example, by trying some gentle exercises, such as isometric holds or “ribcage arms” from Pilates. These exercises focus on engaging your muscles in a static way, offering a gentle form of exercise that can help soothe symptoms without exacerbating fibromyalgia pain.

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Diagnosing fibromyalgia with tender points

When you're trying to figure out this whole chronic pain puzzle, fibromyalgia is like the piece that only fits after you've made sure all the other pieces aren't the right ones.

Imagine your body as a pain map, fibromyalgia is when the whole map lights up. Checking yourself for fibromyalgia tender points is a good first step, but it's not the whole picture. Your doctor will also want to know about other symptoms that you experience, such as always feeling tired, being unable to sleep well, or struggling to think straight. And it's not just for a day or two; it's a grind for at least three months straight.

Fibromyalgia tender points self-test

If you want to check your tender points, gently press on the various body parts highlighted above. If these areas feel unusually sore, it could be a sign of fibromyalgia tender points.

Keep in mind that this self-check is just a preliminary step. It's not definitive. Self-testing is no substitute for professional medical advice. So, rather than just self-diagnosing through touch, it's crucial to consult with a healthcare provider for a comprehensive evaluation and to discuss effective treatment options.

Why are tender points no longer counted today?

Fibromyalgia used to be diagnosed by checking for pain in the various tender points. However, that method is hit and miss because it’s hard to standardize the pressure or type of touch applied. This means that different doctors get different results, and some cases of fibromyalgia can slip through the cracks.

Recognizing these issues, the American College of Rheumatology decided it was time for a change in 2019. They rolled out new guidelines that take a broader look at fibromyalgia, beyond just those tender spots, to better capture the full scope of what patients go through1. This includes widespread pain, along with other symptoms such as fatigue, tummy troubles, mood disturbances, brain fog and any of the other many varied fibromyalgia symptoms that people can experience.

What can make tender pain points worse?

There are a few things that can turn up the pain on those tender spots if you have fibromyalgia. Knowing what these triggers are can really help you keep the discomfort in check and make your days a bit brighter.

  • Physical and emotional stress: If you're overworked, get injured, or if you're feeling anxious or down, your muscles might tense up, making the pain worse2.
  • Sleep quality: Bad sleep can dial up how much pain you feel. Getting good rest can make a big difference3.
  • Weather changes: Some studies suggest that when it gets cold and damp, or when the air pressure changes, it might make your symptoms stronger. More research is needed, but it's something to watch out for4.
  • Hormonal fluctuations: Changes in hormone levels, particularly for people during their menstrual cycle, pregnancy, or menopause, can ramp up fibromyalgia symptoms5,8,9.
  • Diet and nutrition: Eating foods that are high in sugar or caffeine, or that are heavily processed, might set off more pain.
  • Exercise: Not moving enough can actually make the pain stick around, but doing the right kind of exercise can help you get stronger, more flexible, and manage stress better. It's all about finding that sweet spot where you're active without overdoing it.

Treating fibromyalgia tender points

Addressing fibromyalgia's tender points involves a comprehensive strategy that tackles both the mental and physical facets of the disorder.

The gold standard is the biopsychosocial model – a multidisciplinary approach that uses a blend of therapeutic interventions, lifestyle modifications, pharmaceuticals and complementary treatments that both manages symptoms and enhances life quality for those impacted.

Retraining your pain response

Retraining your pain is a bit like training a puppy – it takes patience, understanding, and a bit of know-how. Pain isn't just a physical thing; it's also about what's going on in your life, your thoughts, and your social scene.

Get to know what sets off your pain – is it stress, something you believe, or maybe a habit? Once you've got a handle on that, you can start tweaking things. This could mean changing up your diet, getting better sleep, moving more, or using brain-training techniques to help your brain and central nervous system to deal with stimuli differently.

With a bit of time and effort, you can teach your brain to handle things in a new way, which can mean less ouch and more living your life.

Here are a few things to try.

Stress management

Stress hormones, such as cortisol, can amplify the body's perception of pain, making any discomfort feel much worse. Completely avoiding stress might be impossible, but there are several strategies to help manage stress levels and mitigate your body's response to stress.

Techniques such as cognitive behavior therapy (CBT), mindfulness meditation, relaxation exercises, and seeking emotional and social support from friends, therapists, or support groups can be beneficial.

Movement & exercise

Engaging in movement and exercise can alleviate pain, elevate your spirits and energy, and enhance the quality of your sleep. It's possible to customize physical activity to accommodate your symptoms and limitations, and it doesn't necessarily need to be structured exercise! Any form of active pastime is beneficial, such as yoga, dancing, or gardening.

Our primary pieces of advice are to take it easy at the start and practice self-compassion. Initiating your exercise journey with gentle, low-impact activities and progressively building up the intensity and length helps your body adjust without undue stress. Being compassionate with yourself aids in facing challenges with determination and positivity.

Sleep quality

Sleep is very important when you're dealing with fibromyalgia – it's a big piece of the puzzle for keeping pain at bay. There's this tricky cycle where a bad night's sleep can make your symptoms worse, and then those symptoms make it hard to get good sleep. It's like they're tag-teaming against you.

We know that getting a good night's sleep can feel next to impossible, but try these tips to help keep those fibromyalgia symptoms in check:

  • Stick to a regular sleep schedule. Try to hit the hay and wake up at the same times every day, aiming for about eight hours of shut-eye.
  • Keep naps short and sweet. If you need to sleep during the day, stick to a quick power nap because if you snooze for too long, it can interfere with your sleep at night.
  • Get moving during the day. Some exercise can actually help you fall asleep faster when bedtime rolls around.
  • Ease up on the screen time before bed. The glow from your phone or laptop isn't doing you any favors when it's time to wind down.
  • Make your bedroom a sleep sanctuary. Keep it dark and quiet to help you stay asleep through the night.
  • Watch the afternoon coffee runs. Caffeine can hang around in your system for many hours and make it tough to fall asleep later.
  • Skip the big meals and booze right before bed. They can throw off your sleep quality.
  • Don't just think about sleep – consider other ways to rest and recharge your body and mind. It all adds up to better handling of fibromyalgia symptoms.

Trigger point injections for fibromyalgia

Do you get those tiny, tight lumps that you can feel right under your skin? They can impact the nerves around them, making you hurt in places far from the actual muscle knot.

Trigger point injections are an option that some people find useful to target those muscle knots that just won't relax. Although more research is needed to confirm just how helpful these injections are.

Acupuncture treatment

Acupuncture is a Chinese traditional treatment in which tiny needles are inserted into problem areas in the body. This treatment can help to dial down pain and improve sleep in some people7, although not everyone, so chat to your healthcare team to find the best solutions for you.

Trigger point massage therapy for fibromyalgia

Trigger point massage can help relax sore muscles, especially if they are tight from too much activity or certain injuries. If you want to try massage, make sure the massage therapist understands what fibromyalgia is all about, so they can give you a massage that's comforting, not painful.

And because everyone's body responds differently, talk with your massage therapist to customize the massage to what works best for you.

Medication

Medication is one piece of your treatment puzzle, but it's not the whole solution. The best approach uses medication as a helping hand, so you can engage in other helpful strategies, such as retraining your brain and tweaking your daily habits.

Lots of different medicines can be used for the symptoms of fibromyalgia, including:

  • everyday painkillers such as aspirin and ibuprofen that you can grab from any pharmacy
  • antidepressants, for example, amitriptyline or duloxetine – they're not just for your mood, they can also take the edge off the pain
  • Low Dose Naltrexone (LDN), which can shake up the way your body feels pain and inflammation
  • anti-seizure drugs such as pregabalin and gabapentin, which can calm down jumpy nerves.

Remember, your doctor is the go-to person for your medications and all other treatments. Always speak to them about what is best for you, before you start trying something new.

More information & support

For more information and support, fill out our suitability survey or get in touch. We can help you to work towards reducing pain severity, flare-up frequency, and emotional distress.