I've been told I have myofascial pain syndrome. The diagnosis is made on the basis of the number of tender points on the body. But three different people have examined me, and they all used a different amount of pressure to test for those tender points. It makes me wonder if the test is really accurate. Won't everyone have tender points if you press hard enough?

Myofascial Pain Syndrome (or MPS) is a term used to describe one of the musculoskeletal conditions characterized by chronic pain. It is associated with trigger points (TrPs). TrPs are tender points in the muscles. Sometimes they are referred to as hyperirritable nodules within a taut band of muscle. When pressed, these points trigger a painful response. When palpated by the examiner, the tissue is very tight. Sometimes a knot is felt within the muscle.

Despite many studies looking for a way to reliably diagnose trigger points and myofascial pain syndrome, there isn't one test everyone can use with the same results. As you experienced, the same palpation can be done but with varying degrees of pressure.

Most examiners follow the nail blanch method of testing for trigger points. They use the amount of pressure it takes to cause the examiner's own nailbed to turn white when pressed against the examiner's own palm. Some say they use the amount of pressure it takes to indent a tennis ball.

Certainly, pain or tenderness will occur if enough pressure is applied. The clinician who is examining a patient for trigger points will use the digital palpation test along with a few other guidelines. They will feel for that taut band and knot in the muscle. Most people with true trigger points report with a painful response with very little pressure. It doesn't take much to reproduce their painful symptoms.