One hundred forty patients with mechanical neck pain were randomized to receive either thoracic spine manipulation combined with cervical range of motion exercise (n=70) or stretching and strengthening exercises only (n=70). The primary outcome was disability measured by the Neck Disability Index (NDI). Secondary outcomes included pain intensity, global rating of change (GROC), and fear-avoidance beliefs. Outcomes were assessed at 1 week, 4 weeks, and 6 months. Overall, the results of the study revealed that the manipulation plus exercise group had significantly greater improvements in disability across all follow-up periods and in pain at the 1-week mark compared to the exercise-only group. The findings suggest that thoracic spine manipulation offers additional benefit in reducing disability and short-term pain in patients with neck pain, independent of their clinical prediction rule status.