The Difference Between Tender Points and Trigger Points

by Karen Lee Richards Patient Advocate

When people talk about fibromyalgia, they sometimes use the terms tender points and trigger points interchangeably. In actuality, they have quite different meanings. All accurately diagnosed FM patients have tender points; some may also have trigger points.

Tender Points

Tender points are used to help diagnosis fibromyalgia. They are extremely sensitive spots on the body that elicit pain when four kilograms (or about 10 lbs.) of pressure are applied. There are 18 specific tender points located at nine bilateral locations.

Tender points occur on both the right and left sides of the body at these nine locations:

  1. Occiput: bilateral, at the suboccipital muscle insertions. (Where the neck muscles attach at the base of the skull)

  1. Low cervical: bilateral, at the anterior aspects of the intertransverse spaces at C5-C7. (Front lower neck)

  2. Trapezius: bilateral, at the midpoint of the upper border. (Midway between the neck and shoulder)

  3. Supraspinatus: bilateral, at origins, above the scapula spine near the medial border. (Muscle over the upper inner shoulder blade)

  4. Second Rib: bilateral, at the second costochondral junctions, just lateral to the junctions on upper surfaces. (Edge of upper breast bone)

  5. Lateral epicondyle: bilateral, 2 cm distal to the epicondyles. (2 cms below side bone at elbow)

  6. Gluteal: bilateral, in upper outer quadrants of buttocks in anterior fold of muscle. (Upper outer buttock)

  7. Greater trochanter: bilateral, posterior to the trochanteric prominence. (Hip bone)

  8. Knee: bilateral, at the medial fat pad proximal to the joint line. (Just above the knee on the inside)

Pain in at least 11 of the 18 tender points is required for an FM diagnosis.

Trigger Points

A trigger point is a place on the body that, when pressure is applied, refers (or "triggers") pain to another part of the body. The point itself may or may not be sensitive. Trigger points generally involve taut, ropy bands of muscle fibers. There may also be hard lumps or nodules in the area.

Trigger points are formed when acute trauma or repetitive microtrauma leads to the development of stress on muscle fibers. Although anyone can have trigger points, they are frequently associated with a form of chronic muscle pain called myofascial pain syndrome. It's not unusual for someone with fibromyalgia to also have MPS, which may be one of the reasons tender points and trigger points are often confused.

Summarizing the Differences

Tender Points

Trigger Points

The specific point is tender.

The point itself may or may not be tender.

Tender points do not cause referred pain.

Trigger points refer pain to other areas.

There are always multiple points.

There may be a single point or multiple points.

Points occur in specific symmetrical locations.

Points may occur in any skeletal muscle.


Alvarez, D.J. and Rockwell, P.G. (2002, February, 15). "Trigger Points: Diagnosis and Management." American Family Physician, 65/No. 4, Retrieved May 25, 2008, from

Fibromyalgia Tender Points Identified By The American College of Rheumatology in 1990. Retrieved May 25, 2008, from FM Partnership Web site

© 2008 Karen Lee Richards
Last updated: 12/26/08

Karen Lee Richards
Meet Our Writer
Karen Lee Richards

Karen is the co-founder of the National Fibromyalgia Association. She writes for HealthCentral as a patient expert for Pain Management.