Fibromyalgia Syndrome Tender Points: Where Are They?

Fibromyalgia syndrome tender points are 18 small spots on the body that doctors used to press on, to help decide whether someone had fibromyalgia. Many people hear the term and wonder where the spots are and whether the test still counts. This page answers both. It is general information that sits alongside medical care, and it is not a way to test yourself.

Fibromyalgia is common. The NHS notes that close to one person in every twenty could live with some degree of it (NHS, 2022). So if tender points are part of your story, many others share it.

The 18 fibromyalgia syndrome tender points

The tender point exam came from the 1990 criteria of the American College of Rheumatology, a large body of rheumatology doctors. A doctor pressed on 18 set spots with a thumb, using about 4 kilograms of force. The spots come in nine pairs, one on each side. To meet the 1990 criteria, a person needed widespread pain for at least three months, and the pressing had to feel painful, not merely tender, at 11 of the 18.

In plain words, the nine pairs sit here:

• the base of the skull
• the low front of the neck
• the middle of the top of the shoulder
• just above the bony ridge (spine) of the shoulder blade, near its inner edge
• the upper chest, where the second rib joins its cartilage beside the breastbone
• just below the bony point of the outer elbow
• the upper outer buttock
• just behind the bony bump at the side of the hip
• the inner knee, on a soft pad just above the joint line

These are ordinary places where muscles and tendons meet bone, and many people without fibromyalgia find them a little sore under firm pressure. Tender points are not damaged tissue. Scans and blood tests do not show damage at these spots. The tenderness is thought to reflect a nervous system that has turned up the volume on pain signals, an idea we explore in our guide to central sensitization.

Do doctors still use tender points?

Mostly not. The ACR published new criteria in 2010 and revised them in 2016, and these dropped the tender point exam. Two things came to matter instead:

1. The widespread pain index. This counts how many areas of the body hurt.
2. The symptom severity score. This rates how strong fatigue, sleep trouble and thinking difficulties are.

Why the change? Pain moves. A person's sore spots can differ from one week to the next, so a fixed count was unreliable. The exam also missed many people who had widespread pain and exhaustion but fewer than 11 tender spots. And it left out the fatigue, unrefreshing sleep and foggy thinking that people often say are as hard as the pain itself.

Under the newer approach, symptoms need to have been present at a similar level for at least three months. The 2010 version also asked that no other condition explain them. The 2016 revision added that pain must be spread across at least four of five body regions, and said fibromyalgia can be diagnosed alongside other conditions. Doctors still check for conditions that can look similar, such as an underactive thyroid or inflammatory arthritis. That is why diagnosis belongs with your doctor, who may order tests.

What the fibromyalgia syndrome tender points idea can still teach us

The old exam left one useful thing behind. It showed that the body can be sore in many places at once, and that this soreness is real, even when nothing shows on a scan. If you want to understand why this might happen, our Feldypedia article on fibromyalgia and widespread sensitivity goes deeper. And if you wonder whether doubters have a point, read is fibromyalgia a real condition.

I am a Feldenkrais® teacher, not a doctor, so I never judge a diagnosis. What I can offer is a different relationship with a sensitive body. In the Feldenkrais Method®, we do not press on sore spots to find them. We pay slow, gentle attention to the whole body: how the ribs move with breath, how the feet meet the floor, where effort can soften. Many people notice that this kind of attention feels safer than prodding. The Feldy lessons are short and easy, and you set the pace. For ideas on where to begin, see exercises for fibromyalgia.

One thing to ask or notice

At your next visit, you could ask your doctor: "How do you decide this is fibromyalgia for me, and what else have we ruled out?" Or simply notice, without pressing, whether your sore places change from day to day. A short note of what you find can help your doctor see the pattern.

Common Questions about fibromyalgia syndrome tender points (FAQ)

Do doctors still use tender points to diagnose fibromyalgia?

Mostly no. The tender point exam came from the 1990 criteria. The 2010 criteria, revised in 2016, replaced it with a count of painful body areas and a score for fatigue, sleep and thinking. Some clinicians still press on sore spots as part of an exam, but the count of 11 is no longer required.

How many tender points are there in fibromyalgia?

The 1990 criteria listed 18 tender points, arranged as nine pairs, one on each side of the body. A person needed pain, not just tenderness, under firm thumb pressure at 11 of the 18, plus widespread pain lasting at least three months.

Where are the fibromyalgia tender points located?

They sit at the base of the skull, the low front of the neck, the middle of the top of the shoulder, just above the spine of the shoulder blade, the upper chest beside the second rib, just below the outer elbow, the upper outer buttock, just behind the bony bump at the side of the hip, and the inner knee just above the joint. Each one appears on both sides.

Why were tender points dropped from the criteria?

Pain moves from day to day, so the count could change between visits. The exam also missed many people who had widespread pain and exhaustion but fewer than 11 sore points. The newer approach also asks about fatigue, sleep and thinking, which people with fibromyalgia often report.

Can I check my own tender points at home?

It is not a good idea. Pressing on yourself cannot give a reliable result, because pressure varies and sore spots are common in many people. A doctor looks at your whole story and rules out other causes. If your pain worries you, book a visit rather than testing.

When is it time to get my pain checked?

Book a visit if aching has lasted beyond a few weeks, is spreading, or comes with exhaustion, poor sleep or foggy thinking. Go sooner for fever, weight loss without trying, a hot swollen joint, or new numbness or weakness.

How is this different from myofascial pain?

Myofascial pain is usually local, tied to a tight band of muscle with a trigger point that refers pain nearby. Fibromyalgia pain is widespread and comes with fatigue, sleep trouble and thinking changes. Only a clinician can tell which pattern fits you.