Sixty-six patients with mechanical neck pain (MNP) were randomized to receive cervical manipulation plus neck retraction exercise (CM+NRE; n=33) or neck retraction exercise alone (NRS; n=33). The primary outcomes were visual analogue scale (VAS) for pain and cervical range of motion (CROM). Secondary outcomes included the neck disability index (NDI), neck muscle strength, and cervical sagittal alignment parameters (RRA, C2–7ARA, and c2–7SVA). Outcomes were measured at baseline, immediately after first treatment, at 4 and 8 weeks. Overall, the results of the study revealed that the combined treatment led to significantly greater and faster improvements in pain (VAS), range of motion, disability, and cervical alignment than exercise alone. This suggests that cervical manipulation provides added benefit to exercise in accelerating recovery and improving alignment in patients with MNP.