BACKGROUND: Strain-Counterstrain (SCS) therapy is a manual therapeutic technique used to treat myofascial pain by addressing tender points through passive positioning. Despite anecdotal evidence, limited peer-reviewed research supports its efficacy in chronic low back pain (LBP). This study evaluates the effects of SCS combined with exercise on pain severity, lumbar range of motion (ROM), and functional disability in patients with chronic LBP. METHODS: A randomized controlled trial was conducted with 30 participants aged 45 to 55 years, divided into Group A (SCS plus Exercise) and Group B (Exercise Only). Outcome measures included pain intensity, lumbar ROM (flexion, extension, side bending), and functional disability (Oswestry Disability Index). Assessments were conducted at baseline and after four weeks of intervention. MANOVA was performed to evaluate group, time, and interaction effects, with detailed univariate follow-ups and effect sizes. Reliability of ROM measurements was ensured using intraclass correlation coefficients (ICC > 0.90). RESULTS: MANOVA revealed statistically significant group, time, and interaction effects for all outcomes (Wilks' Lambda 0.065, F[6, 51] 91.34, p < 0.001). Pain severity decreased by 26.7% in Group A compared to 5.2% in Group B (F[1, 56] 65.78, p < 0.001, partial eta2 = 0.77). Lumbar ROM improved significantly in Group A for flexion (10.9%), extension (20.3%), and right-side bending (17.7%) (p < 0.001, partial eta2 0.68 to 0.74), with no significant improvement in left-side bending. Functional disability scores reduced by 25.2% in Group A versus 2.3% in Group B (F[1, 56] 53.45, p < 0.001, partial eta2 0.73). CONCLUSION: SCS therapy combined with exercise significantly reduces pain, improves lumbar ROM, and enhances functional capacity in patients with chronic LBP compared to exercise alone. These findings highlight SCS as a promising adjunctive treatment for managing chronic musculoskeletal pain. Future studies should investigate long-term outcomes and further refine treatment protocols.

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