Types of Sacralization (Castellvi Classification)

• Type I: Enlarged transverse process (usually mild)
• Type II: Partial fusion with pseudo-joint (often painful)
• Type III: Complete fusion (unilateral or bilateral)
• Type IV: Mixed Type (Type II + III)

Bertolotti’s Syndrome

Lower back pain caused by sacralization due to pseudo-joint inflammation or abnormal spinal mechanics.

• Pseudo-joint inflammation
• L4-L5 disc stress
• Nerve irritation
• SI joint dysfunction

Why Sacralization Causes Pain

• Increased stress on L4-L5 disc
• Uneven spinal loading
• Pseudo-joint inflammation
• Sacroiliac joint dysfunction
• Muscle imbalance

Symptoms of Sacralization

• Lower back and buttock pain
• Pain worse with sitting or standing
• Reduced spinal mobility
• Radiating leg pain (in some cases)
• Morning stiffness
• Postural imbalance

Our Assessment Approach

• Posture and gait analysis
• Lumbar range of motion testing
• SI joint evaluation
• Neurological screening
• Muscle strength testing
• Imaging review (X-ray / MRI)

Physiotherapy Treatment

• Joint mobilization (lumbar & SI joints)
• Soft tissue release
• Core strengthening exercises
• Postural correction
• Dry needling (if required)
• Electrotherapy (TENS / IFT / Ultrasound)

Rehabilitation Program

• Core stability training
• Lumbar mobility exercises
• Pelvic stability training
• Functional movement training

Self-Care Advice

• Maintain correct posture
• Avoid heavy lifting
• Do regular core exercises
• Take breaks from long sitting
• Stay physically active
• Maintain healthy body weight

Benefits of Physiotherapy

• Pain reduction
• Improved mobility
• Better posture
• Stronger core stability
• Reduced recurrence
• Avoids surgery in most cases

Frequently Asked Questions

Can physiotherapy help sacralization?

Yes, physiotherapy is highly effective in managing symptoms and improving function.

Is surgery required?

Most cases do not require surgery and respond well to conservative treatment.

How long is recovery?

Recovery depends on severity but improves with consistent physiotherapy.