Neck pain continues to be a prevalent condition in our society. Manual therapy (hands on techniques for the treatment of neck pain is an intervention commonly implemented in clinical practice. Recently researchers and clinicians have implemented manual therapy techniques to the thoracic spine (midback) to treat patients with neck pain. To date no studies have examined the short-term combined effects of thoracic spine manual therapy and cervical spine manual therapy in the treatment of patients with mechanical neck pain. The purpose this study is to assess the combined effects of thoracic spine thrust manipulation with cervical spine non-thrust manipulation in patients with neck pain.

Inclusion Criteria:

• Neck pain of less than 3 months
• No symptoms below the shoulder
• Baseline Neck Disability Index score of 10 or greater

Exclusion Criteria:

• Red flags noted in the patient's Medical Screening Questionnaire (i.e. tumor, fracture, metabolic disease, rheumatoid arthritis, osteoporosis, prolonged use of steroid, etc)
• History of whiplash injury within the past two months
• Diagnosis of cervical spinal stenosis
• Uni-lateral or bi-lateral upper extremity radicular symptoms
• Evidence of central nervous system involvement
• Two or more positive neurological signs consistent with nerve root involvement: myotomal muscle weakness, dermatomal sensory loss, diminished or absent reflexes
• Prior surgery to the neck or thoracic spine
• Pending legal action regarding their neck pain, or patients with no fault or workers compensation claims
• Insufficient English language skills to complete the questionnaires
• Inability to comply with treatment and follow-up schedule
• Women who may be pregnant