Tender points are specific sites on the body that cause pain when pressed. The pain may spread when a tender point is pressed and causes pain in a larger area (for example, down the leg, arm, or back).

There are 9 pairs of tender points. Each pair has one point on each side of the body, for a total of 18 points. These pairs are located:

1. At the back of the neck behind the ear, where the neck muscles attach to the base of the skull.
2. About halfway between the base of the neck and the tip of the shoulder.
3. At the spot where the back muscles attach to the shoulder blade.
4. On the front of the neck above the collarbone.
5. Just to the right and left of the breastbone (sternum) about 2 in. (5 cm) below the collarbone.
6. On each forearm just below and to the outside of the crease of the elbow.
7. Just above and to the outside of each buttock.
8. On the outer upper leg just behind the bony part of the hip (this point is easier to find when standing).
9. On the inside of each knee.

For a clear diagnosis of fibromyalgia, according to the American College of Rheumatology guidelines, a person must have pain at 11 or more of the 18 tender points. In practice, though, many people with fibromyalgia have fewer than 11 tender points.

Experts call these tender points, but you may also hear them called trigger points.