Foreshocks are among the most powerful tools to study the processes that occur before main earthquakes. However, their detection is still sparse, especially for relatively small earthquakes. We present here a detailed foreshock analysis for the 2019 Balsorano (Italy) earthquake (Mw4.4). To improve the detection before and after the mainshock, we use receivers at distances of <75 km from the targeted seismicity, through template matching. To improve the understanding of the mechanism(s) behind the earthquake initiation, we detail the evolution of the sequence associated to this earthquake, using waveform clustering and hypocenter relocation. Differences between foreshocks and aftershocks are revealed by this analysis. Moreover, distinct patterns associated to the different seismic activities are revealed. The observed behavior highlights a complex initiation process, which apparently starts on an adjacent antithetic fault. Finally, the aftershock activity comprises different clusters with distinct spatio-temporal patterns, which suggests that each cluster has distinct triggering mechanism(s).