Comparing Myofascial Exercise and Trigger Point Therapy for Non-Specific Low Back Pain

The goal of this clinical trial is to learn if two common physical therapy approaches, used alone or together, can help reduce pain and improve daily function in adults with nonspecific low back pain. Nonspecific low back pain means low back pain without a clear medical cause. The main questions this study aims to answer are: 1. Does hands-on pressure to painful muscle spots (called myofascial trigger point therapy) help lower low back pain? 2. Does a guided exercise program that focuses on how muscles work together help lower low back pain? 3. Does combining hands-on therapy with exercise work better than using either approach alone? Researchers will compare three groups to see which approach leads to greater improvement. One group will receive hands-on trigger point therapy, one group will do a specific exercise program, and one group will receive both treatments. Participants will: * Be assigned to one of the three treatment groups by chance * Receive treatment twice a week for four weeks * Complete simple assessments before treatment starts, after the first treatment session, and after the final session The results of this study may help physical therapists choose better noninvasive treatment options for people with nonspecific low back pain.

Inclusion Criteria: * Adults aged 18 to 65 years * Nonspecific low back pain lasting longer than 6 weeks * Average low back pain intensity of 3 or higher on a 0-10 Numeric Pain Rating Scale * Presence of at least 6 myofascial trigger points identified across bilateral target muscles * Presence of muscle function impairments in at least 6 muscle groups based on functional muscle testing * Able to understand study procedures and participate in an exercise-based intervention * Willing and able to attend treatment sessions and complete study assessments Exclusion Criteria: * Currently pregnant * Diagnosed spondylolisthesis or vertebral compression fracture * Known malignancy or history of cancer affecting the spine * Previous lumbar spine surgery * Known neurological, infectious, or systemic disease that may affect pain or movement * Any other medical condition that, in the opinion of the investigators, would interfere with safe participation in the study