Objective To investigate the clinical efficacy of prone position five-directional neck muscle strength training combined with Mulligan manipulation in the treatment of cervical spondylosis of cervical type. Methods A total of 82 patients with cervical spondylosis of cervical type admitted to the Department of Rehabilitation and Physiotherapy, Pingdingshan Medical Area of the 989th Hospital of the Joint Logistics Support Force of the Chinese People’s Liberation Army from January 2022 to June 2025 were prospectively enrolled. According to the random number table method, they were divided into control group and combined training group, with 41 cases in each group. The control group received conventional cervical traction combined with the Mulligan manipulation therapy. The combined training group, based on the intervention plan of the control group, additionally applied prone position five-directional neck muscle strength training. Both groups had a treatment course of 6 weeks. The clinical efficacy, cervical range of motion, cervical pain [Northwick Park neck pain questionnaire (NPQ), short form-McGill pain questionnaire-2 (SF-MPQ-2)], pain-related serum factors [prostaglandin E2 (PGE2), β -nerve growth factor (β -NGF)] before and after treatment were compared between the two groups. Results The treatment efficacy rate of the combined training group was 92.68% (38/41), which was higher than that of the control group [75.61% (31/41)] (P＜0.05). The flexion, left lateral flexion, right lateral flexion and extension activities of the cervical spine in both groups were significantly increased compared to before treatment (all P＜0.05), and the improvement in the combined training group were greater (all P＜0.05). The NPQ scores and standard scores of SF-MPQ-2, the PGE2 and β -NGF levels in both groups were significantly reduced compared to before treatment (all P＜0.05), and the reduction in the combined training group were greater (all P＜ 0.05). After 6 months of follow-up, the recurrence rate of the combined training group was 4.88%, which was significantly lower than 17.07% of the control group (P< 0.05). Conclusion Prone position five-directional neck muscle strength training combined with Mulligan manipulation can improve the clinical efficacy of cervical spondylosis of cervical type, effectively relieve pain and improve the function of cervical spine movement.