Validation of CPR for Manipulation for Neck Pain

Inclusion Criteria: * Primary complaint of mechanical neck pain with or without unilateral upper extremity symptoms (mechanical neck pain is defined as neck pain/ symptoms that are altered/ affected by activity, movement and posture) * NDI score at least 10 points out of 50. Exclusion Criteria: * Red flags noted in the patient's Neck Medical Screening Questionnaire (i.e. tumor, fracture, metabolic diseases, Rheumatoid Arthritis, osteoporosis, prolonged history of steroid use, etc.) * History of whiplash injury within the past six weeks * Diagnosis of cervical spinal stenosis or bilateral upper extremity symptoms * Evidence of central nervous system involvement, to include hyperreflexia, sensory disturbances in the hand, intrinsic muscle wasting of the hands, unsteadiness during walking, nystagmus, loss of visual acuity, impaired sensation of the face, altered taste, the presence of pathological reflexes (i.e. positive Hoffman's and/or Babinski reflexes), etc. * Two or more positive neurologic signs consistent with nerve root compression, including any two of the following: a. Muscle weakness involving a major muscle group of the upper extremity b. Diminished upper extremity muscle stretch reflex (biceps brachii, Brachioradialis, or triceps reflex) c. Diminished or absent sensation to pinprick in any upper extremity dermatome * Prior surgery to the neck or thoracic spine * Pending legal action regarding their neck pain * Insufficient English language skills to complete all questionnaires * Inability to comply with treatment and follow-up schedule