The purpose of this study is to evaluate how certain procedures work for individuals with chronic neck pain.

Individuals who are 18 years of age or older and have chronic neck pain will participate in this study. The study involves randomly assigning individuals into two treatment groups (i.e. manual therapy and resistance exercise). Both treatments are recommended treatments and are part of clinical practice guidelines and are well supported in the literature.

Participants will be asked to complete a 4-week training program which includes physical examination, education, treatment, and an exercise plan. Participants will also complete a brief set of questionnaires at their baseline visit, 4 weeks, and 6 months after their initial visit

We are looking to examine the various factors that contribute to the changes seen with Physical Therapy for chronic neck pain. These factors include the components of care involving the way a patient perceives their pain or disability, as well as the interaction with their care giver, which contribute to the effect of the Physical Therapy (PT) treatment. The study will assign subjects to one of three groups. The first group will receive a manual therapy treatment approach, the second will receive a simulated manual therapy treatment approach and the third will receive no treatment and act as a waitlist control. This design will allow us to tease out the effects of the treatment itself compared with the other factors which may contribute to change as well as any improvement which occurs as result of natural history. You will be seen for an initial assessment where you will complete surveys and measurements will be performed looking at how far you can move and the way that you move your neck. You will then be seen for 3 additional visits weekly over the next three weeks if you are assigned to the manual therapy or simulated manual therapy group. You will be seen for an initial visit and a follow up after three weeks if you are assigned to the waitlist/control group. All groups will complete the surveys and have repeat measurements performed at the final follow up visit.

The purpose of the study is to examine whether certain neck strengthening exercises result in change in size of the neck muscles being targeted.

Musculoskeletal Ultrasound is a non invasive, safe tool that will be used to measure the size of certain muscles in your neck. This will allow us to determine if these muscles actually get bigger in response to targeted exercise. Muscle size is a factor associated with strength.

This study will help us tease out the time it takes to create neck muscle hypertrophy, or increase in muscle size, in order to develop effective protocols for neck strengthening which may be useful in the management of chronic neck pain.

Weakness in certain neck muscles may be associated with the development of neck pain and we hope to determine effective training protocols for these neck muscle groups.