24 patients suffering from acute neck pain and meeting 4 out of 6 clinical prediction rule (CPR) criteria for thoracic thrust joint manipulation (TJM) treatment for neck pain where randomized into either a group receiving cervical TJM or Thoracic TJM, followed by 3 sessions of a standardized exercise program. The results indicated that cervical TJM resulted in greater reduction in self reported pain, neck disability index score (NDI), and results on the Fear-Avoidance Beliefs Questionnaire-Physical Activities (FABQ-PA). These results demonstrate that cervical TJM provides better outcomes for patients in comparison to thoracic TJM and should be considered the standard of treatment, unless there are contraindications present.