(646) 355-8777

Herman & Wallace Blog

Tarlov Cyst and Pelvic Pain

Tarlov Cyst

Some of our patients will present with sacral or coccygeal pain, and the potential causes of this pain are numerous. One potential cause of sacrococcygeal pain is a Tarlov cyst, which occur when the nerve root sheaths are swollen and fill with cerebrospinal fluid. The condition can be very painful and can affect bowel, bladder, and sexual dysfunction due to the location of the nerves that may be compressed from the swelling. To learn more about the possible causes of Tarlov cyst formation, you can find a lot of information on the tarlovcystfoundation.org site. Symptoms might include low back and buttock pain, neurologic symptoms in the lower extremities, pain with sitting, and swelling over the sacral area. Pelvic dysfunction including bowel or bladder changes, rectal or vaginal pain, or painful intercourse can occur. The pain might worsen with forward flexion due to nerve tension, and pressure changes in cerebrospinal fluid can contribute to headaches or vision disturbances.

Unfortunately, most of our patients present with some or all of the above complaints, so how do we participate in the process of determining when the patient needs to return to a medical provider? In addition, these cysts might be discovered as an “incidental” finding on an imaging study, and the medical provider may complete further tests to determine if the cyst is causing the patient’s symptoms. The most important aspect of screening for dysfunction such as a Tarlov cyst, which can progress to significant neurologic impairment if symptomatic and eft untreated, is keeping track of our patient’s symptom progression and neurologic signs. Getting a baseline lower extremity neurologic screen for every patient with pelvic pain or dysfunction is an critical skill so that we can communicate any significant worsening or lack of progress to the medical provider. Such a lower extremity neurologic scan should include sensation testing, deep tendon reflexes, and signs such as Babinski and clonus tests.

Patients will also present to pelvic rehabilitation after having had a Tarlov cyst repair. Surgeries can include drainage of the cyst followed by use of a fibrin glue to occlude the cyst in hopes of preventing recurrence. The American Association of Neurological Surgeons points out on their website that surgery may not eliminate the patient’s symptoms, and care involving supervised pain management may be appropriate. From a rehabilitation standpoint, these patients may or may not be finding their way to a pelvic rehab practitioner. Is there a provider in your area who may be treating these patients and who is not aware that you have skills to offer? Interventions such as pain management strategies, modalities, movement therapy, manual therapy, treatment directed to neurodynamics, and general wellness education may all play a role in helping patients recover from procedures for Tarlov cysts.

To learn more about treatment of pain in the coccyx area, you can sign up for faculty member Lila Abbate’s Coccyx Pain Evaluation and Treatment continuing education course, with the next opportunity to take the class in Torrance, California, at the end of March.

What is Tai Chi, and Can it Help Our Patients?
Katie Middleton - Featured Certified Pelvic Rehabi...

Upcoming Continuing Education Courses

Pregnancy Rehabilitation - Seattle, WA (SOLD OUT)

Feb 22, 2020 - Feb 23, 2020
Location: Pacific Medical Centers

Manual Therapy Techniques for the Pelvic Rehab Therapist - Pasadena, CA

Feb 22, 2020 - Feb 23, 2020
Location: Huntington Hospital

Pelvic Floor Level 2B - Alexandria, VA (SOLD OUT)

Feb 28, 2020 - Mar 1, 2020
Location: Inova Physical Therapy Center

Pelvic Floor Level 2B - Fort Worth, TX (SOLD OUT)

Feb 28, 2020 - Mar 1, 2020
Location: University of North Texas Health Science Center

Pediatric Functional Gastrointestinal Disorders - Charlotte, NC

Feb 28, 2020 - Mar 1, 2020
Location: Novant Health

Rehabilitative Ultrasound Imaging: Orthopedic Topics - Raleigh, NC

Feb 28, 2020 - Feb 29, 2020
Location: Rex Hospital

Pelvic Floor Series Capstone - Phoenix, AZ (SOLD OUT)

Mar 6, 2020 - Mar 8, 2020
Location: 360 Sports Medicine & Aquatic Rehabilitation Centers

Pelvic Floor Level 1 - Salida, CO (SOLD OUT)

Mar 6, 2020 - Mar 8, 2020
Location: Heart of the Rockies Regional Medical Center

Pelvic Floor Level 1 - Columbia, MO

Mar 6, 2020 - Mar 8, 2020
Location: University of Missouri-Smiley Lane Therapy Services

Pelvic Floor Level 1 - Princeton, NJ (SOLD OUT)

Mar 6, 2020 - Mar 8, 2020
Location: Princeton Healthcare System

Pelvic Floor Level 1 - New Orleans, LA (SOLD OUT)

Mar 6, 2020 - Mar 8, 2020
Location: Ochsner Health System

Mobilization of the Myofascial layer: Pelvis and Lower Extremity- Grand Rapids, MI

Mar 6, 2020 - Mar 8, 2020
Location: Spectrum Health System

Bowel Pathology and Function -Salt Lake City, UT

Mar 7, 2020 - Mar 8, 2020
Location: Veterans Administration - Salt Lake City

Postpartum Rehabilitation - Washington, DC (SOLD OUT)

Mar 7, 2020 - Mar 8, 2020
Location: GWUH Outpatient Rehabilitation Center

Pelvic Floor Level 1 - Virginia Beach, VA (SOLD OUT)

Mar 13, 2020 - Mar 15, 2020
Location: Sentara Therapy Center - Princess Anne

Pelvic Floor Level 2A - Philadelphia, PA (SOLD OUT)

Mar 13, 2020 - Mar 15, 2020
Location: Thomas Jefferson University

Pelvic Floor Level 1 - Manchester, NH (SOLD OUT)

Mar 13, 2020 - Mar 15, 2020
Location: Franklin Pierce University

Meeks Method for Osteoporosis - Minneapolis, MN

Mar 14, 2020 - Mar 15, 2020
Location: Park Nicollet Clinic--St. Louis Park

Pelvic Floor Level 2A - Minneapolis, MN (SOLD OUT)

Mar 20, 2020 - Mar 22, 2020
Location: Allina Hospitals and Clinics

Nutrition Perspectives for the Pelvic Rehab Therapist - San Diego, CA

Mar 20, 2020 - Mar 22, 2020
Location: Comprehensive Therapy Services

Pelvic Floor Level 1 - Birmingham, AL (SOLD OUT)

Mar 20, 2020 - Mar 22, 2020
Location: Shelby Baptist Medical Center

Mobilization of Visceral Fascia: The Urinary System - Carlsbad, CA

Mar 20, 2020 - Mar 22, 2020
Location: Tri-City Medical Center

Pelvic Floor Level 1 - Bellingham, WA (SOLD OUT)

Mar 20, 2020 - Mar 22, 2020
Location: PeaceHealth- St. Joseph Medical Center

Pelvic Floor Level 1 - Los Angeles, CA (SOLD OUT)

Mar 20, 2020 - Mar 22, 2020
Location: Mount Saint Mary’s University

Breastfeeding Conditions - Phoenix, AZ

Mar 21, 2020 - Mar 22, 2020
Location: Banner Physical Therapy and Rehabilitation

Breathing and the Diaphragm: Orthopedic Therapists - Sterling Heights, MI

Mar 27, 2020 - Mar 29, 2020
Location: Henry Ford Macomb Hospital

Breathing and the Diaphragm: Pelvic and Orthopedic Therapists - Sterling Heights, MI

Mar 27, 2020 - Mar 29, 2020
Location: Henry Ford Macomb Hospital

Pelvic Floor Level 1 - Corvallis, OR (SOLD OUT)

Mar 27, 2020 - Mar 29, 2020
Location: Albany Sport & Spine Physical Therapy

Breast Cancer Rehabilitation - Alexandria, VA

Mar 28, 2020 - Mar 29, 2020
Location: Inova Physical Therapy Center