As preparation, the technique is explained to the patient and that in this approach, mutual collaboration between the operator and the patient is necessary.

Several muscle energy techniques address dysfunction at the OA joint, AA joint, and within the remaining cervicals. 

Occipitoatlantal Dysfunction Muscle Energy

1. Diagnose dysfunction of the OA joint (i.e., OA flexed, rotated left, side bent right (F RlSr)). 
2. Using one hand to hold the patient's head, place the other hand at the OA junction to monitor articulation of the joint.
3. Place the patients head towards the barrier, or in opposition to the diagnosis. (i.e., If the patient is OA F RlSr,  Rotate the patient to the right, side bend to the left, and extend). 
4. Instruct the patient to attempt to move their head back into a neutral position and provide an isometric force for 3 to 5 seconds.
5. Reposition the patient further in the direction of the barrier, and repeat step 4. 
6. Repeat steps 4 through 5, three to five times, and reevaluate the dysfunction.[9]

Atlantoaxial Dysfunction Muscle Energy

1. Diagnose dysfunction of the AA joint (i.e., AA Rotated Left (Rl)). 
2. Holding the head of the patient with both hands, flex the neck to lock out the joints below the level of the AA joint. 
3. Rotate the patient's head toward the barrier (i.e., If AA Rl, rotate the patient to the right).
4. Instruct the patient to attempt to move their head back into a neutral position and provide an isometric force for 3 to 5 seconds. 
5. Reposition the patient further in the direction of the barrier, and repeat step 4. 
6. Repeat steps 4 through 5, three to five times, and reevaluate the dysfunction.[10]

C2-C7 Dysfunction Muscle Energy

1. Diagnose dysfunction of a vertebra (i.e., C4 Flexed, Rotated Right, Sidebent Right (C4 F RrSr)). 
2. While holding the patient's head with one hand, palpate the articular pillars with the other hand at the level of the dysfunctional vertebrae. 
3. Place the patients head towards the barrier, or in opposition to the diagnosis. (i.e., If the patient is C4 F RrSr, Rotate the patient to the left, side bend to the left, and extend). 
4. Instruct the patient to attempt to move their head back into a neutral position and provide an isometric force for 3-5 seconds.
5. Reposition the patient further in the direction of the barrier, and repeat step 4. 
6. Repeat steps 4 through 5, three to five times, and reevaluate the dysfunction.[11]

Adverse complications are rare; however, they may include stroke, disc herniation, fractures, or hematomas.[3] In a systematic review, the most frequently described major adverse event was cervical arterial dissection (CAD). However, there is currently not sufficient evidence to establish a risk profile for patients susceptible to this complication.[12]

This type of osteopathic approach is indicated not only for vertebral release but also for muscle relaxation. Very often, the deep muscles of the cervical tract can be a source of pain, not only local but also in the head, stimulating trigeminal pain. In fact, the sub-occipital muscles (3 out of 4) have a myodural bridge, the latter of which is innervated and rich in proprioceptors. A contracture of these muscles or the presence of triggers points can trigger migraines and headaches. In the acute phase, METs can be performed and relieve symptoms.

The technique stimulates correct intervention of the parasympathetic system and facilitates the restoration of the passage of fluids (blood and lymph).The MET approach can improve the function of the respiratory accessory muscles of the cervical tract, increasing the ventilatory capacity of patients with fibromyalgia.[13]

Chronic neck pain can result from previous trauma; in these cases, the contractile content of the muscles decreases, while the adipose tissue increases. In this clinical context, local inflammation (pain) increases, and the proprioceptive capacity of the muscular districts decreases with consequent deterioration of the neuromotor coordination (pain). MET can help restore not only proper spinal joint space but improve the ability of muscles to stretch and shorten comprehensively. This last point will allow the neck muscles to implement their function, reducing the causes of the pain.

MET can improve the morphology of the cervical tract (curvature); it could be a strategy for faster recovery from trauma such as whiplash.[2]

If the patient's cervical tract is very painful and not very mobile, it is possible to start using METs, using the eye muscles in conjunction with the small movements of C0-C2. Or, involve the lingual complex and movement of the cervical tract, up to C4.

Muscle energy of the cervical spine is a useful, non-invasive option for patients diagnosed with somatic dysfunctions. While an osteopathic clinician performs manipulative therapy in an office setting, overall patient outcomes can be improved by combining exercise with manipulative treatment and employing a multidisciplinary approach. In a systematic review by Hidalgo et al., multiple manipulative treatments combined with exercise, was more effective at reducing chronic neck pain, than manipulative therapies alone. [Level 1]

Chronic neck pain accounts for 25% of all outpatient visits for physiotherapy, and between 50 to 85% report recurrence.[14] Therefore, it is imperative to develop a treatment plan with maximum efficacy to reduce rates of recurrence and improve overall patient outcomes.

The osteopath should always interact with other health figures, such as the physiotherapist, the speech therapist, and others. In the literature, it is clear that, very often, METs are used in combination with non-osteopathic treatments to improve the patient's clinical picture more quickly.

It is clear that, if osteopathic treatment (in this case, with the use of METs) is effective, the patient's health stands out in the daily or routine visits by other health professionals.