Tarlov cysts are fluid-filled sacs that often form on the sacral spine. These perineural cysts contain cerebrospinal fluid (CSF), the liquid that surrounds and cushions your brain and spinal cord.
Many people with Tarlov cysts don’t even know they have them. But sometimes, these cysts can cause pain and neurological problems. Exercise can be a great way to manage symptoms, but it’s important to know which activities could make things worse.
In this article, we’ll define Tarlov cysts, discuss the symptoms and diagnosis, and most importantly, focus on exercises to avoid if you have them.
What are Tarlov cysts?
Tarlov cysts, also called perineural cysts, are fluid-filled sacs that usually appear in the sacral region of the spine. They’re located in the space between the dura and arachnoid mater, close to the nerve root. The fluid inside the cysts is cerebrospinal fluid (CSF), the same fluid that bathes and cushions your brain and spinal cord.
It’s not unusual for Tarlov cysts to show up as incidental findings on an MRI, with about 4.6% of lumbar or sacral spine MRIs revealing these cysts. However, most people never know they have them. Only about 20% of Tarlov cysts ever cause symptoms.
Symptoms and diagnosis
Tarlov cysts don’t always cause symptoms, but when they do, they can include:
- low back pain
- leg pain
- pain when moving from sitting to standing
- numbness
- urinary urgency or frequency
- sexual dysfunction
In some cases, radiculopathy and bowel or bladder dysfunction can also occur, and in rare instances, these can lead to cauda equina syndrome, a serious condition that requires immediate medical attention.
If your doctor thinks you may have Tarlov cysts, they’ll likely order an MRI, CT scan, or myelogram. Another diagnostic technique is percutaneous aspiration, in which fluid is removed from the cyst to see if it relieves symptoms.
General Exercise Considerations for Tarlov Cysts
Living with Tarlov cysts can be challenging, but movement and exercise can still be a part of your life. Here’s what to keep in mind:
Individualized plans are key
The most important thing is to work with your healthcare team to develop an exercise program that’s right for you. A spine specialist and physical therapist can help you design a routine that takes into account your specific symptoms, overall health, and personal preferences.
Low-impact exercise is often best
Low-impact activities are generally recommended because they can help you maintain strength and flexibility without making your symptoms worse. Walking, swimming, and gentle stretching are often good choices.
Know when to stop
If any exercise increases your pain or causes new neurological symptoms, stop immediately. It’s important to communicate any changes in your symptoms to your healthcare providers so they can adjust your treatment plan as needed.
Exercises to Avoid with Tarlov Cysts
When you have Tarlov cysts, some exercises are best avoided, as they can increase the pressure on the cysts and make your symptoms worse.
High-impact activities
Generally, high-impact activities are not recommended. These can include running, jumping, plyometrics, and lifting heavy weights.
Activities Involving Spinal Compression or Flexion
Exercises that compress the spine or involve extreme bending should be approached with caution. Limit or modify deep squats, sit-ups, crunches, forward folds, and heavy overhead presses.
Activities Involving Straining or Valsalva Maneuver
You’ll also want to avoid activities that cause straining or the Valsalva maneuver, where you hold your breath during exertion. These actions raise the pressure in your abdomen, which can affect the cysts. Limit or modify heavy lifting, intense core work, and certain yoga poses.
In one case report, symptoms were exacerbated by high-impact activities. This underscores how important it is to come up with an exercise plan that’s tailored to your situation and to monitor your body carefully as you exercise.
Frequently Asked Questions
Is heat good for Tarlov cysts?
Heat therapy might provide temporary relief from muscle spasms or pain associated with Tarlov cysts for some people. However, it’s essential to consult with your doctor or physical therapist before using heat, as it may not be suitable for everyone. What works for one person might not work for another.
What is the best medication for Tarlov cysts?
There isn’t a single “best” medication for Tarlov cysts because treatment is highly individualized. Pain management often involves medications like NSAIDs, nerve pain medications (gabapentin, pregabalin), or, in some cases, stronger pain relievers. Always discuss medication options with your doctor.
What aggravates Tarlov cysts?
Activities that put pressure on the sacral area, like prolonged sitting, heavy lifting, or high-impact exercises, can aggravate Tarlov cysts. Also, straining during bowel movements can increase pressure. It’s important to identify your personal triggers and modify activities accordingly.
What exercises are good for Tarlov cysts?
Gentle exercises like walking, swimming, and specific physical therapy exercises designed to strengthen core muscles and improve posture can be beneficial. Low-impact activities are generally preferred. Working with a physical therapist is crucial to develop a safe and effective exercise program tailored to your specific needs and limitations.
In Closing
If you’re living with Tarlov cysts, it’s important to be thoughtful about the exercises you choose. In general, it’s best to avoid high-impact activities and exercises that put pressure on the lower back and sacrum.
The ideal approach is to work with your healthcare providers to develop an exercise plan that’s safe and effective for you. Remember that managing Tarlov cysts involves more than just exercise. It also involves pain management and potentially other treatments tailored to your specific needs.