The trigger points shown on the diagram above (click to enlarge), are those to which sufferers with Fibromyalgia can find extremely tender.

The American College of Rheumatology classified Fibromyalgia using the tender point examination along with a detailed case history, and then produced a set of guidelines which opened up the floodgates of diagnosis of this complex condition. These stated that the criteria for a diagnosis of Fibromyalgia should include tenderness in at least 11 out of the 18 possible sites, coupled with widespread pain and a case history of multiple symptoms not indicative of any other major disorder.

It was suddenly realised that a large percentage of those attending Rheumatology Clinics had these criteria and thus the number of peopled getting the diagnosis of Fibromyalgia rose quite sharply.

Some doctors may press so hard on the points that even someone without the condition would flinch, or other factors such as excessive fat in the area or heavy clothing may not allow complete or unreliable testing.

Those with Fibromyalgia sometimes find the slightest touch quite disturbing, or at the very least irritating, and there is evidence that those suffering from the syndrome have a lowered pain threshold, so care should be taken when checking their points for tenderness.

Don't try and check for the points yourself, as they are very specific areas (and sometimes quite a small area involved), as it takes someone very knowledgeable and experienced in anatomy to be able to locate them accurately.

It should also be pointed out that in a minority of cases, trigger point examination is either completely negative, or inconclusive whereby maybe only 5 or 6 points are tender, but everything else will point towards this diagnosis nonetheless. If you are in this category, your Rheumatologist may keep an eye on your progress to ensure an accurate diagnosis.

You are unlikely to be brought back for check-ups on a regular basis with this condition, as doctors may feel at present there is so little they can do treatment wise, and their current caseload is so heavy with as yet undiagnosed cases.

These are the general areas involved in the location of trigger points; 

• at the base of the skull beside the spinal column
• at the base of the neck in the back
• on the top of the shoulder toward the back
• on the breastbone
• on the outer edge of the forearm about 2 cm below the elbow
• over the shoulder blade
• at the top of the hip
• on the outside of the hip
• on the fat pad over the knee.

To get a formal diagnosis of Fibromyalgia, your doctor or rheumatologist must find at least 11 of these 18 tender points. However, what is tender on one day may not be on another. Therefore, if you have some number less than 11 but meet the other criteria for FM (widespread pain, muscular stiffness, and difficulty getting restful sleep) you would do well to follow a good regimen for managing Fibromyalgia even though you don't have all the required tender points to qualify for a formal diagnosis.