One hundred fourteen patients with chronic nonspecific low back pain were randomized to receive either dry needling combined with spinal manipulative therapy (n=57) or spinal manipulative therapy alone (n=57). The primary outcome of interest was functional disability, measured by the Roland–Morris Disability Questionnaire. Secondary outcomes included lumbar muscle endurance, assessed using the Sorensen test. Outcomes were evaluated at baseline, 4 weeks, 8 weeks, and 6 months post-intervention. Overall, the results revealed that both treatments effectively reduced functional disability and improved endurance, but the combination therapy showed significantly greater benefits at all time points. These findings suggest that dry needling, when combined with spinal manipulative therapy, offers enhanced efficacy in managing chronic nonspecific low back pain.