Fibromyalgia syndrome is a common disorder characterized by multiple tender points, widespread deep muscle pain, sleep disturbance, fatigue and depression. The cause and cure for fibromyalgia is unknown, but medications and other treatments can helps to reduce the symptoms. Although, people experience pain and tenderness all over the body, they are often diagnosed by the doctors based on the tender spots or points in certain places of the body.
What are tender points?
Tender points are pain points or localized areas of tenderness around joints but not the joints. These tender points hurt when pressed with a finger. Tender points are often not deep areas of pain. Instead, they are superficial areas under the surface of the skin, such as the area over the elbow or shoulder.
These tender points will hurt when pressed but the pressure will not cause pain in any other part of the body. The physician applies a standardized amount of pressure, about 4kg. Remember, a tender point has to be painful at palpation, not just “tender”. When pressed, these areas tend to feel like bruises in various stages of healing.
Also, a tender point is different from what you may know as a trigger point. Tender points hurt, trigger points hurt and refer to other body parts. Trigger points cause myofascial pain syndrome, which often co-exists with fibromyalgia, but can be treated with massage, physical therapy or gentle stretching. When muscles feel hard and pressing on them causes a response elsewhere in the body or even nausea, trigger points are responsible. Tender points are caused by an unknown mechanism and their severity is often cyclic. Tender points do not generally respond to physical therapy, often becoming more painful with pressure.
Widespread pain is defined as having pain in both sides of the body and pain above and below the waist. In addition, pain must also be present in the cervical spine, anterior chest, thoracic spine or lower back.
These tender points are located at:
Occiput: At the suboccipital muscle insertions (near the base of skull).
Low cervical: At the anterior aspects of the inter-transverse spaces at C5-C7 (the lower vertebra of the neck).
Trapezius: At the midpoint of the upper border (the neck, mid back and upper back muscles between the shoulder blades).
Supraspinatus: At origins, above the scapula spine near the medial border.
Second rib: Upper lateral to the second costochondral junction (the insertion of the second rib).
Lateral epicondyle : 2cm distal to the epicondyles (the side of the elbow).
Gluteal: In upper outer quadrants of buttocks in anterior fold muscle (the upper and outer muscles of the buttocks).
Greater trochanter: Posterior to the trochanteric prominence (the upper part of the thigh).
Knee: At the medial fat pad proximal to the joint line (the middle of the knee joint).
Tender Points Vs. Trigger Points:
What is the difference between tender points and trigger points and how will it impact your treatment?
For starters, 90% of the 18 predetermined tender points are actually myofascial 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 the other regions while pressing on a tender point is believed to only cause discomfort to the local area. The finding that most of your tender points are actually trigger points is good news because it opens up your treatment options. There are specific therapies for relieving the painful knots in the muscle where the trigger points are located and research shows that relieving the pain of just one trigger point that can have a significant effect on reducing your body wide pain.
One of the most popular approaches is therapeutic massage, which involves working out the trigger points to try get the muscles to relax. In fact, 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.