 The sample size was calculated using Gpower 3.1F test, analysis of variance ANOVA: repeated measure, within between interaction, and a priori: compute required sample size. A result of 10 participants treatment group5 and sham group5 was used to calculate the effect size ES of 0.44 for the pressure pain threshold on the cervical spine after the interventionimmediate effect between group. The power estimated for ANOVA for the two group with a significance of 0.05 revealed that a total sample size of 28 participants was necessary to obtain a power of 0.80. . a minimum of 14 needed to be recruited in this study Participants with unilateral neck pain and radiating symptoms to upper extremity of more than three months were recruited from King Abdul-Aziz Hospital and East Jeddah general hospital in Jeddah, Saudia Arabia All patients signed a consent form before they participate in the study after explaining all procedures to them. The study was approved by the Institutional Review Board IRB at the University of Dammam IRB Number: PGS-20160-30-142 and was approved by ministry of health at Saudia Arabia IRB number: H-02J-002. All electronic data pertinent to the patients were being saved in a secured laptop, whereas the paper document will be kept in a locked cabinet. 