Bobby Nourani DO FAAO - Long Lever Techniques: An Illustrated Guide for Practitioners to Treat Neuro-Musculoskeletal Pain

I write from the perspective of one who experienced the discomfort of coccydynia for many months after a protracted and difficult labor. While that particular discomfort is thankfully now more than four decades in the past, it appears that our understanding of the aetiopathology of coccydynia and the rationale(s) for clinical management of the condition remain works in progress. I therefore have a very personal reason to welcome the blend of anatomy applied to clinical practice and clinical insight that Dr Nourani details in this book.

Susan Standring MBE, PhD, DSc, FKC, Hon FRCS, Emeritus Professor of Anatomy, Kings College London, and Editor-in-Chief of Grays Anatomy (39ed-42ed)

The Long Lever Technique is a unique blend of principles that were developed by generations of osteopathic pioneers. With a strong basis in anatomy and physics and an understanding of functional physiology (including the primary respiratory mechanism), this technique offers something of value to any of the osteopathic approaches you typically use in your practice.

Rachel Brooks, MD

A well-organized, efficient, and easy-to-apply treatment that is practical for students, residents, and physicians of all levels.

Michael A. Seffinger, DO

This is a practical and well-illustrated manual that guides the practitioner through all aspects of applying this technique. I use Long Lever Technique for exaggeration of the lesion in an indirect approach. Now, after reviewing this book I intend to try this more direct method as well.

Eliott Blackman, DO

Long Lever Technique is a beautiful melding of structure and function and uses the principles of applied anatomy in a direct and efficient manner. It acknowledges the underlying forces of the Breath of Life while addressing the structural problems encountered in both acute and chronic conditions. This book is a welcome addition to the osteopathic literature.

Christopher Muller

Copyright 2022 by Bobby Nourani. All rights reserved. No portion of this book, except for brief review, may be reproduced, stored in a retrieval system, or transmitted in any form or by any meanselectronic, mechanical, photocopying, recording, or otherwisewithout the written permission of the publisher. For information contact North Atlantic Books.

Illustrations by William Kuchera, Zac Miller, and Bobby Nourani, DO, FAAO
Treatment technique and anatomical overlay photos by Jim Keating
Beauchene skull reprinted with permission from Kenneth Lossing, DO
Historical images reprinted with permission from the Museum of Osteopathic Medicine, Kirksville, MO: [1985.1023.08] Andrew Taylor Still; [2015.67.01] William Garner Sutherland, DO; [1980.482.01] Leather helmet photograph.

Published by

North Atlantic Books
Huichin, unceded Ohlone land
aka Berkeley, California
Cover photos by Jim Keating
Cover design by Jasmine Hromjak
Book design by Happenstance Type-O-Rama

Long Lever Techniques: An Illustrated Guide for Practitioners to Treat Neuro-Musculoskeletal Pain is sponsored and published by North Atlantic Books, an educational nonprofit based in the unceded Ohlone land Huichin (aka Berkeley, CA), that collaborates with partners to develop cross-cultural perspectives, nurture holistic views of art, science, the humanities, and healing, and seed personal and global transformation by publishing work on the relationship of body, spirit, and nature.

North Atlantic Books publications are distributed to the US trade and internationally by Penguin Random House Publishers Services. For further information, visit our website at www.northatlanticbooks.com.

MEDICAL DISCLAIMER: The following information is intended for general information purposes only. Individuals should always see their health care provider before administering any suggestions made in this book. Any application of the material set forth in the following pages is at the readers discretion and is their sole responsibility.

Library of Congress Cataloging-in-Publication Data

Names: Nourani, Bobby, 1981 author. | Huff, Richard, 1943- author.
Title: Long lever techniques : an illustrated guide for practitioners to
treat neuro-musculoskeletal pain / Bobby Nourani, DO, FAAO & Richard
Huff, DO.
Description: First. | Berkeley, California : North Atlantic Books, [2022] |
Includes bibliographical references and index.
Identifiers: LCCN 2021038713 (print) | LCCN 2021038714 (ebook) | ISBN
9781623176785 (trade paperback) | ISBN 9781623176792 (ebook)
Subjects: LCSH: Musculoskeletal systemDiseasesTreatment. | Osteopathic
medicine.
Classification: LCC RC925 .N68 2022 (print) | LCC RC925 (ebook) | DDC
616.7dc23/eng/20211008
LC record available at https://lccn.loc.gov/2021038713
LC ebook record available at https://lccn.loc.gov/2021038714

North Atlantic Books is committed to the protection of our environment. We print on recycled paper whenever possible and partner with printers who strive to use environmentally responsible practices.

Dedicated to my family and friends, the best cheerleaders I could have. Dad, your endless love and positive affirmations spring me forward. Mom, your hunger for learning is infectious. My sisters, Moriah and Sereena, your existence alone makes me strive to be a better person. Last but not least, to my mentors and patients who have instilled me with trust and confidence as I have developed. Ultimately this book is dedicated to Dr. Huff, to those he was inspired by, and to those like me who carry on his legacy.

Bobby Nourani, DO, FAAO

In Memory of the Originator of the Long Lever Technique

Richard G. Huff, DO

May 7, 1943January 28, 2019

As members of Dick Huffs family, we watched him build his medical practice, discover new manipulation methods, and develop what ultimately became the Long Lever Techniques outlined in this manual. We often benefited from and were willing participants in his trial-and-error search for improved manipulation. But the professional side of Dick was, in our world, just a part of his wonderful presence. He joined his wife Pat in a grand adventure to build a life they both wanted together. Pat and Dick worked and celebrated together for fifty-one years. He taught his son Brett by example, care, and helpful suggestion. Brett remembers daily Dicks virtues of intellectual curiosity, hard work, empathy, and the joys of a good meal and bottle of wine with family and friends. Later in life, Dick devoted himself to developing relationships with his daughter-in-law and grandchildren. They remember him as a kind soul who pushed them to read books. We can hear his voice in this manual. We know he would be excited to collaborate with so many accomplished physicians, sharing ideas to help improve patient health.

Pat Huff and Brett, Katie, Carter, and Vivian Huff

Dick Huff was deeply accomplished at osteopathic manipulative medicine and an innovative, relentlessly curious physician. He gathered effective but disparate techniquesboth those he discovered and developed through experimentation and those he adopted from other expert practitionersand combined them into a system outlined in Long Lever Techniques. I worked closely for many years with Dick at Mercy Health Partners watching and helping him advance and develop the practice of OMM across the United States. But Dick was much more than his professional accomplishments: he was one of my oldest and closest friends. He was kind, caring, humble, empathic, and loving. He loved his wife without condition, was both an exemplary father and a close friend to his son, and loved spending time with his daughter-in-law and his two grandchildren. I hear Dicks ideas and enthusiasm in this manual, and I miss my friend and his smile, tenderness, and wit. I wish all the readers of