Long Lever Techniques: An Osteopathic Manual

Bobby Nourani, DO, FAAO
Richard G. Huff, DO

Charlie Back, DO, FAAO
Kenneth Lossing, DO
Michael Carnes, DO, FAAO
Francois L. Cyr, MBA
William P. Powell, DO
Katherine Heineman, DO
David Rakel, MD
Edward G. Stiles, DO, FAAO, Dist.
Michael L. Kuchera, DO, FAAO, FNAOME
Benjamin J. Visger, DO
William A. Kuchera, DO, FAAO

$79.95 + tax

Book Description:

The content and ideas presented in this text are based on experiences in an osteopathic musculoskeletal medical practice and are intended to be a practical manual. The intention is to put forth a unique and effective treatment technique. The works and teachings from Andrew Taylor Still, DO and William Garner Sutherland, DO provide the foundation for the principles and methods presented. Drs. Nourani and Huff do not intend to reiterate their thought processes, rather to advance knowledge or provide a different perspective from which to view these recurring issues in a musculoskeletal practice.


The Long Lever Technique combines principles of Osteopathy in the Cranial Field with more manual techniques of the axial skeleton and limbs. The result is time efficient treatments with good clinical outcomes that can be performed by both novice and advanced providers. The illustrations, anatomical overlays, and descriptions are meant to stimulate clinical growth and applications of osteopathic concepts.


This manuscript introduces an osteopathic manual medicine treatment approach not yet documented. Long Lever Technique is a direct treatment to normalize flow of the primary respiratory mechanism at the site of somatic dysfunction. Immediate benefits include reestablishing the cranial rhythmic impulse (CRI), primary respiratory mechanism (PRM), and/or inherent potency at the site of dysfunction. It is a direct treatment technique improving the PRM of restricted skeletal structures by applying concepts of osteopathy in the cranial field to the axial skeletal system. Integrating proper structural mechanics of the spine with the PRM produces profound effects. This direct technique improves tolerability for the elderly patient with no audible “pop” inherent with high velocity low amplitude (HVLA) techniques. Compared to muscle energy requiring active patient involvement, LLT is a passive and practitioner-driven technique. Patient positioning and treatment are adjusted according to the PRM. The site of the somatic dysfunction demarcates interruption of the PRM quality and amplitude proximal and distal to the affected site. Use of the appendages and head as long levers creates an amplified input flow of the PRM directed to the fulcrum that is the area of somatic dysfunction. This provides a greater output flow of the PRM released through the restricted barrier. Long lasting benefits include increased mechanical range of motion, and ultimately enhanced and normalized PRM potency of the affected skeletal structures. Identifying the areas of greatest restriction and normalizing the primary respiratory mechanism across the restriction reduces the number of areas requiring treatment.


Original credit and education of Long Lever Techniques is respectfully due to the teachings and wisdom of Richard Huff, DO. Dr. Huff was a graduate of the A.T. Still University, Kirksville class of 1970. In 2007, Dr. Nourani first witnessed Dr. Huff’s creative treatment approach that yielded a high-quality benefit in a relatively short treatment duration. Through Dr. Huff’s direct teaching and Dr. Nourani’s own clinical experience with patient improvement, Dr. Nourani became convinced that other clinicians would appreciate this knowledge as well.