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bstract Background: Mechanical neck pain (MNP) is a significant health issue that impacts more severely on daily functioning and professional productivity than low back pain, highlighting the need for effective treatments. Objectives: This study aimed to address the gap in existing research by investigating the synergistic effects of combining manual therapy and exercises, on pain, functional abilities, ROM and deep cervical flexor muscle endurance in MNP patients. Methods: This is a randomized experimental study recruited 45 female patients with chronic mechanical neck pain from Jouf University, assigning them to one of three groups: group A: manual therapy, group B: therapeutic exercises, and group C: a combination of both treatments. Assessments was done at baseline and after 4 weeks of treatment utilizing the Neck Disability Index, Range of Motion measurements, the Pain Numeric Rating Scale and Cranio-Cervical Flexion Test (CCFT). Results: All treatment groups experienced significant improvements post-treatment, with notable decreases in the Numerical Pain Rating Scale (NPRS) and Neck Disability Index (NDI), and increases in Cranio-Cervical Flexion Test (CCFT) and neck Range of Motion (ROM), each with p values less than 0.005. Particularly noteworthy was Group C, which received a combination of manual therapy and therapeutic exercises, exhibited significantly better outcomes in reducing NPRS and NDI, as well as enhancing CCFT and neck ROM, compared to Groups A and B (p < 0.05). However, there was no significant difference observed between Groups A and B in their posttreatment outcomes (p > 0.05), indicating similar efficacy when manual therapy and therapeutic exercises are employed independently. Conclusions: The study concluded that an integrated approach combining manual therapy, therapeutic exercises was more effective in improving pain, disability, and neck functionality in patients with chronic mechanical neck pain compared to singular treatment approaches
