Before starting the exercise, patients will be taught to reduce the lumbar lordosis by contracting and drawing in the abdominal muscles and to find the 24 lumbar and pelvic neutral position by moving the pelvis forwards and backwards (pelvic tilt, bridge, bird-dog and plank etc.). In each session, the neutral position will be found first and attention will be paid to maintain the neutral position throughout the exercise. In addition, core stability exercises including simultaneous contractions of the multifidus and pelvic floor muscles will be given in different positions such as supine, prone, crawling, bridge, kneeling, sitting and standing. The exercises will consist of 3 levels (from easy to difficult). In the advanced level exercises, patients will be asked to maintain the neutral curvature of the lumbar spine, resistance limb exercises will be added and the exercises will be completed gradually. Each exercise will be performed for 3 sets of 8-10 repetition.

The exercise will consist of movements in all directions of thoracic spine flexion, extension, lateral flexion, and rotation. In the thoracic spine extension exercise, both hands will be locked behind the wrists and the back will be placed on a foam roller with the feet positioned 25 flat on the floor. The knee will be maintained at 90° to perform the extension exercise on the foam roller. The hands will be locked with the elbow on a chair. After kneeling, the hip will be moved toward the heels to extend the thoracic spine. In the thoracic spine flexion exercise, the thoracic spine will be flexed by moving backward until the hip touched the heels in a quadruped position.The rotation exercise will be conducted with patients lying on their sides.The elbows will be straight and the palms will be held together. The leg facing the ceiling will be bent to the level of the stomach. Then, the arm facing the ceiling will be moved backward in a large arc to rotate the thoracic spine.

Before starting the exercise, patients will be taught to reduce the lumbar lordosis by contracting and drawing in the abdominal muscles and to find the 24 lumbar and pelvic neutral position by moving the pelvis forwards and backwards (pelvic tilt, bridge, bird-dog and plank etc.). In each session, the neutral position will be found first and attention will be paid to maintain the neutral position throughout the exercise. In addition, core stability exercises including simultaneous contractions of the multifidus and pelvic floor muscles will be given in different positions such as supine, prone, crawling, bridge, kneeling, sitting and standing. The exercises will consist of 3 levels (from easy to difficult). In the advanced level exercises, patients will be asked to maintain the neutral curvature of the lumbar spine, resistance limb exercises will be added and the exercises will be completed gradually. Each exercise will be performed for 3 sets of 8-10 repetition.

Pain levels in participants were assessed using the Numerical Pain Rating Scale (NPRS-Ar).

Using the Arabic MODI (Appendix III), Patients will be instructed to choose the best answer of the possible answers which describes the level of function and disability during daily activities in each of items of the questionnaire (Alnahdi, 2025).

The Back Range of Motion (BROM) device will be utilized to measure the lumbar range of motion (ROM), as a valid and reliable measure of spinal motion (Kumar & Singh, 2021; Chen et al., 2022), according to established procedures (Madson et al., 1999). After palpating and marking the spinous processes of T 12 and S1 with adhesive dots, a warm-up trial for each plane of motion will be completed by patients. The BROM device will be used to measure active ROM in the order of flexion/extension, right/left lateral flexion, and right/left rotation.

Once the data for each movement was taken, the BROM device was removed, and the skin markers were reapplied after a 10-15 second rest period. Each motion will have three trials, and data from the three trials will be averaged and used for analysis in order to maximize reliability.

Using the Modified Schober Test, Patient will be standing. The examiner will mark both posterior superior iliac spine (PSIS) and then will draw a horizontal line at the center of both marks. A second line is marked 5 cm below the first line. A third line is marked 10 cm above the first line. Patient will be instructed to flex forward as if attempting to touch his/her toes. The examiner re measures the distance between the top and bottom line (Rezvani et al., 2012). Three trials will be conducted and the mean of the three trials will be chosen for the purpose of data analysis