Sixty-five patients with non-specific chronic neck pain were randomized to receive manual therapy (n=30) or a progressive neck-specific exercise program (n=29), each delivered once weekly for four weeks. The primary outcome was a composite “responder” status (meeting MCID in ≥2 of: 24-h pain, Neck Disability Index, and global rating of change). Secondary outcomes included pain intensity (24-h and last week), disability, patient-perceived improvement, health-related quality of life, kinesiophobia, and craniocervical flexion test (CCFT) performance. Outcomes were assessed at baseline, 2 weeks, treatment completion (4 weeks), and 12 weeks post-treatment. Overall, the results of the study revealed no between-group differences in individual continuous outcomes, but manual therapy yielded a higher proportion of responders at all time points; however, these differences disappeared when exercise adherence was ≥95%. With high adherence, exercise improved CCFT more than manual therapy. In short, both interventions are clinically effective; manual therapy’s apparent advantage diminishes when exercise adherence is maximized.