Trigger Points vs. Tender Points

Occasionally, especially when you talk to a lot of FMS patients (or read a lot they've posted to the internet), you'll notice a common confusion: they'll refer to having a certain number of "trigger points" for diagnosis. This is a common confusion between two similar terms that should both be familiar to Fibromyalgia patients.

"Tender Points" (TPs) are eighteen points on the body that are very sensitive to pressure. Pressing gently on the spots (just enough to see white under the fingernail, or about what you'd use to press a piano or keyboard key) causes serious discomfort or pain. Having at least 11 of the 18 tender points on both sides of the body is the major diagnostic criteria for Fibromyalgia Syndrome.

Most Fibromyalgia patients also have "Trigger Points" (TrPs). Trigger Points are not a symptom of Fibromyalgia, but of Myofascial Pain Syndrome (MPS). The worst thing about TrPs to a patient is that they are not only painful themselves, but they can "refer" pain along nerves and muscles so that pain can be felt far away from the problem area. Unlike Tender Points, Trigger Points can be felt from outside as "knots" in tight muscles. Also unlike Tender Point discomfort, the pain of TrPs can be directly treated. Biofeedback and various forms of massage have varying degrees of success with treating TrPs. Various needle techniques, from acupuncture to injections of lidocaine and saline, have also been successful for some patients.

A simple at-home treatment that may help some patients with TrPs is tennis ball massage. The easiest way to use this is just to lie down with a tennis ball under the TrP. If you are not sure exactly where that is, put it in the right area and move around slowly until it feels like the right place. Then, I like to rock back and forth slightly to loosen the muscle and ease relaxation, but that isn't totally necessary. Once you are lying on the tennis ball (and have rolled on it to massage the muscle if you chose), just relax on it as much as possible until the pain has faded to a bearable intensity. Later, use heat, rather than ice, to keep the muscle relaxed; ice can cause muscle tension.