Development of a Clinical Prediction Rulefor Neck Manipulation

Inclusion Criteria: * age 18 to 60 years * primary report of neck pain with or without unilateral upper extremity symptoms * baseline neck disability index score of 10 points (out of 50) or greater Exclusion Criteria: * any medical red flags suggesting that the etiology of symptoms might be nonmusculoskeletal * diagnosis of cervical spinal stenosis (as identified in the patients' medical intake form) * bilateral upper extremity symptoms * evidence of central nervous system involvement * history of whiplash injury within 6 weeks of the examination * pending legal action regarding their neck pain * 2 or more positive neurologic signs consistent with nerve root compression (changes in sensation, myotomal weakness, or decreased deep tendon reflexes) * any history of cervical spine surgery, rheumatoid arthritis, osteoporosis, osteopenia, or ankylosing spondylitis.