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Purpose: Our aim was to compare the efficacy of spinal manipulation of the upper cervical spine (C1-C2) on postural sway in patients with chronic mechanical neck pain with the application of a combination of cervical (C3-C4), cervicothoracic (C7-T1) and thoracic spine (T5-T6) thrust joint manipulation., Methods: One hundred eighty-six ( n  = 186) individuals with chronic mechanical neck pain were randomised to receive an upper cervical spine manipulation ( n  = 93) or three different spinal manipulation techniques applied to the cervical spine, cervicothoracic joint and thoracic spine ( n  = 93). Measures included the assessment of stabilometric parameters using the Medicapteurs S-Plate platform. Secondarily, neck pain was analysed using the Numeric Pain Rating Scale., Results: We observe a decrease in the length of the centre of pressure path, average speed, medio-lateral and antero-posterior displacement with statistically significant results ( p  < 0.05) in the upper cervical manipulation group. Both interventions are equally effective in reducing neck pain after fifteen days ( p  < 0.001)., Conclusion: The application of upper cervical thrust joint manipulation is more effective in improving stabilometric parameters in patients with chronic mechanical neck pain. Trial registration: The study was registered in the Australian and New Zealand Clinical Trial Registry (no. ACTRN12619000546156).Implications for rehabilitationPatients who suffer from neck pain exhibit increased postural sway than asymptomatic subjects.Both spinal manipulation treatments applied in this study are equally effective in reducing neck pain.Spinal manipulation treatment on the upper cervical spine improves postural stability parameters.