The study compared the effectiveness of Tuina therapy combined with resistance exercise (TTRE) versus Tuina therapy alone in 90 patients with mechanical neck pain. Participants had a mean age of 26.4 years (SD 3.1) and 49 (54.4%) were female. Both groups completed two Tuina sessions per week for 4 weeks, with the TTRE group additionally performing resistance exercise three times daily with a progressive number of repetitions (5–20 per session). The primary outcome was change in visual analogue scale (VAS) pain score, where the TTRE group achieved a mean difference of -4.2 (95% CI -4.4 to -4.0) and a between-group difference of 0.5 (95% CI 0.30 to 0.77; p < 0.001) in favor of TTRE. Secondary outcomes included neck disability index (NDI), peak cervical muscle strength, neck range of motion, and flexion angle. The TTRE group showed greater improvements in pain reduction, functional recovery, muscle strength, and range of motion at week 4. The study was registered in the Chinese Clinical Trials Registry (ChiCTR2300068344).