TMS tender points

For audible readers of Think Away Your Pain and others interested in the tender points that I discuss, here is a diagram of those areas.

I have examined many thousands of patients with chronic pain and diagnosed TMS in over 4000 individuals. The majority of them have two or more tender points on exam. Some have 5 or 6. The exam is done lying face down on an exam table (mine has a face cutout for positioning and comfort). I press with two or three fingers, using 2-4 pounds of pressure onto the spots above. Anatomically, these are the trapezius (upper part), quadratus lumborum (laterally, mid lumbar paraspinal) and gluteal (upper, outer) muscles.

Some things that are important: 1) some patients, mostly men, do not report tenderness in any of the spots and still have TMS (confirmed to me by Dr. Sarno in conversations over the years) 2) tenderness may be prominent in areas not close to the actual areas of pain 3) tender points tend to be retained, even as patients are cured of chronic pain (often less tender, however)

It is difficult to do this exam on yourself if not impossible. It does take training to do this correctly. These are not identical to the so-called fibromyalgia points although there is some overlap.

Also, the additional two spots marked with the vertical oval marks above are in the upper iliotibial band and are additional or optional spots to examine. I often check them if people have all six, sometimes if people have none.

I hope this clarifies tender points. They are ONE element of a TMS diagnosis and far from the post important element.