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The Tender Points that Doctors Press on
The fact is that using trigger or tender points as a way of trying to diagnosis Fibromyalgia was a good attempt at trying to find a diagnostic tool that just does not show up on any other diagnostic tests. However, many studies (the most recent being published in the fall of 2011) have shown that this is not a valid or reliable way of determining if a person has Fibromyalgia. However, I would like to explain why this test was first used and unfortunately many doctors are still using it to determine if a person has or does not have Fibromyalgia. This is unfortunate as many who do have Fibromyalgia are told that they don’t while some who do not have Fibromyalgia are told that they do.
Muscle metabolism is a complicated mechanism but in simplistic terms, the end product of muscle metabolism is lactic acid which is generally expelled by the body through the blood and than through the kidneys. When a person has Fibromyalgia, the muscles are in a constant state of contraction. The end product is a buildup of lactic acid being produced which the body cannot expel. The lactic acid then begins to accumulate in the muscle tissue which is very irritating and can damage this soft tissue. As a protective device, the body than produces fibrous tissue (think of cloth or other material), which covers the lactic acid, not allowing it to do further damage to the muscles. By the way, this is where the name Fibromyalgia comes from. Fibro means fibrous tissue, myo means muscle and algia means pain. Of course Fibromyalgia is a lot more than just muscle pain.
When a doctor is pushing on these 18 points (11 of 18 being tender was diagnostic), the doctor is irritating and sometimes breaking down the fibrous tissue leading to pain.
However, Lactic acid (and trigger points) can and are found in almost all people to some extent. For example, an athletic runner, running 5 miles per day will show these tender points. Many people after traumas of one type or another will also exhibit these points. We also live in a very stressful world and most of us are under stress on a daily basis, thus leading to these trigger points.
Dr. Janet Travell, M.D (now deceased) was considered the expert in trigger point mechanisms and trigger point therapy. She co-authored two books on the topic along with her co-author David Simon. Travell spent her career doing this type of research and was extremely well respected in the medical community. In fact she was the personal physician for Presidents John Kennedy and Lyndon Johnson. She passed away at the age of 94 leaving a huge legacy of work related to trigger points. I suspect that if she was alive now, she would have plenty to say about using these tender points to diagnosis Fibromyalgia. Regardless, a thorough history is a better diagnostic method. Hopefully most doctors will catch up with the literature and realize that the tender point test is not a valid diagnostic criterion for Fibromyalgia.