These 18 sore muscle points can tell if you have fibromyalgia
Last updated 21/02/2024 by The pain clinics - Interdisciplinary Health
The 18 painful muscle points that may indicate fibromyalgia
Hypersensitive and sore muscle points are a characteristic symptom of fibromyalgia.
There are 18 painful muscle points that are particularly associated with the chronic pain disorder fibromyalgia. In the past, these muscle points were directly used to make the diagnosis, but things have changed since then. Having said that, they are still used in investigations and diagnostics.
- Still used in diagnostics
A larger, more recent study (2021) looked more closely at the diagnosis of fibromyalgia.¹ They indicated that the diagnosis is still usually made by a rheumatologist based on these criteria:
Long-lasting, chronic pain
Widespread pain involving all 4 quadrants of the body
Significant pain sensitivity in 11 out of 18 muscle points (also called tender points)
But they also recognize how fibromyalgia is a chronic pain syndrome that consists of much more than optional pains. Among other things, they point out how this is a very complex diagnosis.
- Not emphasized as strongly as previously
Before, it was almost the case that if you had results on 11 or more of 18 tender points, you received the diagnosis. But we point out that since this article was first published, the diagnostic criteria have changed, and these points are given less weight than before. But considering how much hypersensitivity, allodynia og muscle aches it is among this patient group; then one can understand why it is still used as part of the diagnosis.
"The article has been written and quality checked by publicly authorized health personnel. This includes both physiotherapists and chiropractors at Pain clinics Interdisciplinary Health (see clinic overview here). We always recommend having your pain assessed by knowledgeable healthcare personnel."
Tips: At the bottom of the guide, you can see a video with recommended gentle exercises adapted to fibromyalgia patients. We also give good advice for self-help against muscle pain, including the use of foam roll og trigger point ball.
Are chronic pain and invisible illness taken seriously enough?
Unfortunately, there are clear indications that these are diagnoses and illnesses that are not being prioritized. Among other things, internal surveys have shown that this patient group is placed at the bottom of the list the popularity list. Is there reason to believe that this affects how healthcare personnel meet and treat these patients? Yes, unfortunately. This is precisely why it is so important that we stand together to fight for patient rights for these diagnoses. We thank everyone who gets involved in our posts and who helps us spread the message via social media and the like.
"Your commitment and dissemination of our issues is worth its weight in gold. Together we are (even) stronger - and can fight together for better patient rights for this neglected patient group."
List: Sore muscle points associated with fibromyalgia
We will go into more detail on where the various aching muscle points are located, but the areas involved include:
The back of the head
knees
hips
Top of the shoulders
Upper part of the chest
Upper part of the back
The 18 muscle points are thus well spread over the entire body. Other names for muscle points are tender points or allogeneic points. Again, we want to make it clear that these are not used exclusively to make the diagnosis, but they can still play an important role.
- Daily relaxation is important
Fibromyalgia patients and several other invisible illnesses have a very active nervous system. Precisely for this reason, it is important that this patient group takes time for themselves and makes use of relaxation techniques. Here there are different individual preferences, but what we can say for certain is that many in this patient group are troubled by tension in the neck and back. Based on this, measures such as neck hammock, acupressure mat, back stretch or massage ball, all come into their own. All links to recommended products open in a new browser window.
Tip 1: Stress down in the neck hammock
Many people report good relief when using what is called neck hammock. In short, it gently stretches the muscles and joints of the neck, while at the same time stimulating a natural and good neck posture. You can press the image or here to read more about it.
Tip 2: Stimulates circulation in the muscles with a massage ball
En massage ball, also often called a trigger point ball, is excellent self-help for sore and tense muscles. You use it directly on areas that are very tense, with the intention of stimulating increased circulation and dissolving muscle tension. This edition is in natural cork. Read more about it here .
Tender points 1 and 2: The outside of the elbows
The first two points are on the outside of the elbows. More specifically, we are talking here about the area where the wrist extensors (the muscles and tendons that bend the wrist back) attach to the lateral epicondyle (the leg outside the elbow).
Tender points 3 and 4: The back of the head
Fibromyalgia is a chronic pain diagnosis with highly sensitive muscles, tendons and nerves - which can be triggered by various factors. The next two sensitive muscle points can be found on the back of the head.
– Craniocervical region
More specifically, we are talking here about the area where the neck meets the transition to the skull, ie the craniocervical transition. In particular, a greatly increased sensitivity has been noted in suboccipital muscle - the four smaller muscle attachments that attach to this area.
Tender points 5 and 6: Inside of the knees
We find points 5 and 6 on the inside of our knees. We point out that when it comes to sore muscle points in the diagnosis of fibromyalgia, it is not a question of common muscle pain - but rather that one is highly sensitive to touch in this area and that pressure on the area, which normally should not hurt , is actually painful.
- Compression noise can provide relief and support
Fibromyalgia is categorized as a form of soft tissue rheumatism. Like many afflicted with rheumatic disorders, so can compression noise (for example knee compression support), exercise in hot water pool and warm pillows, help relieve knee pain.
Tip 3: Compression support for the knee (one size)
Having one knee compression support available is always a good idea. Even if you don't use it every day, it can be extra nice to have when you know you're going to be on your feet more than usual. In such situations, the support can provide both extra stability and protection. You can read more about this here .
Tender points 7, 8, 9 and 10: The outside of the hips
On the hips we find four highly sensitive muscle points - two on each side. The points sit more towards the back of the hips - one on the back of the hip joint itself and one on the back of the outer hip crest.
- Hip pain is a common fibromyalgia symptom
In light of this, it is also not surprising that hip pain is a recurring problem in those with fibromyalgia. Perhaps you have been affected yourself and recognize this? To calm the pain in the hips, we recommend adapted yoga exercises, physical therapy and - in certain, more severe cases that also include calcifications can Shockwave Therapy be favorable.
Tender points 11, 12, 13 and 14: Front, upper part of the chest plate
This area, like the hips, has four hypersensitive points. Two of the points are located just below each side of the inner part of the collarbone (known as the SC joint) and the other two are located further down on each side of the breast plate itself.
- Can be excruciating pain
Experiencing severe chest pain can be very daunting as it provides associations to heart and lung disease. It is always important to take such symptoms and pain seriously, and have them investigated by your GP. Fortunately, the vast majority of cases of chest pain are due to muscular tension or pain from the ribs.
Tender points 15, 16, 17 and 18: Upper back and top of shoulder blades
In the picture above, you see the four points we find in the upper part of the back. Rather, the therapist's thumbs are on two of the points, but we find these on both sides.
Summary: 18 tender points in fibromyalgia (full map)
In this article, we have gone through the 18 tender points associated with fibromyalgia. In the illustration above, you can see a complete map of the 18 points.
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VIDEO: 5 mobility exercises for fibromyalgia patients
In the video below shows chiropractor Alexander Andorff five adapted movement exercises. These are gentle and adapted to people with fibromyalgia and invisible illness. In addition to these exercises, it has also been documented that Stretching can be good for fibromyalgia patients.
These five exercises can help you maintain mobility in a daily life filled with chronic pain. However, we are reminded to pay attention to the day's form and to adapt accordingly.
Help spread the knowledge
Many of you who have read this article may recognize yourself in not feeling heard in the healthcare system. Several of these bad experiences are rooted in a lack of knowledge about invisible illness. And this is precisely what we must do something about. We would like to send a big thank you to everyone who engages, motivates and spreads our posts in social media and links to us in the comment field and more. Over time, together we can contribute to a better general understanding of these diagnoses. Remember that you can also always ask us questions directly on our page on Facebook (The pain clinics - Interdisciplinary Health) - and we really appreciate all the commitment there as well.
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Our clinicians and clinic departments always aim to be among the elite in the investigation, treatment and rehabilitation of pain and injuries in muscles, tendons, nerves and joints. By pressing the button below, you can see an overview of our clinics - including in Oslo (incl Lambert seats) and Akershus (Raw wood og Eidsvoll Sound). Feel free to contact us if you have any questions or are wondering about anything.
Article: 18 painful muscle points in fibromyalgia
Written by: Our publicly authorized chiropractors and physiotherapists at Vondtklinikkene
Fact check: Our articles are always based on serious sources, research studies and research journals - such as PubMed and the Cochrane Library. Please contact us if you spot any errors or have comments.
Sources and research
1. Siracusa et al, 2021. Fibromyalgia: Pathogenesis, Mechanisms, Diagnosis and Treatment Options Update. Int J Mol Sci. 2021 Apr 9;22(8):3891.
Photos (credit)
Image: Map of the 18 tender points. Istockphoto (licensed use). Stock illustration ID: 1295607305 Credit: ttsz
I know myself and know for sure that I have pain in over half the points. Now sat down to check again and find that all the points are painful. Got a referral to a rheumatologist last year from the doctor, but sent it to the hospital and was rejected. Was very sorry because of this and gave up a bit. I have no idea what to do next, because I'm also very nervous about going alone to places I'm not familiar with. Have always been like that. Have had such pain in the body for several years.