Before I explain why the long lever is used in Osteopathy, I should probably explain what it is. The long lever is essentially the use of the arms or legs to mobilize/manipulate any part of the body. I should be slightly more technically accurate and say that the long lever is the use of a body part that is distant from, but directly related to, the part being mobilized (the sacrum can be used as a long lever for the thoracic spine if you know how to do it).
The idea is that by using a lever that is longer, more force can be generated with less effort. This is good for a patient as the long lever means that more work can be done in less time and thus they will not have to work as hard to take on the treatment. Another factor is that the use of a long lever allows for more soft tissue to be used for the mobilization of hard tissue to ensure that the structural/functional relationship is ideal. By employing more soft tissue, not only is more force developed,but there is also less need for specific soft tissue work as it is being mobilized with the long lever. Fascial work is performed as soon as the long lever is moved, muscular tissue is affected in a non-invasive and inhibitory fashion, joints are mobilized and set in to appropriate places, the hard and soft tissue is coordinated with minimal input. All of this is a huge deal because the patient receives effective treatment and does not have to be pushed/pulled/rolled around a table for an hour.
The long lever approach allows for all “techniques” to be available to an Operator at all times. If one “technique” is not working, simple changes in the manipulation of the long lever allow for a different “technique” to be employed without altering the patient’s position. With less work for the patient and more possibilities for the operator, the long lever approach is much more physiologically inhibitory and appealing.
As Osteopathic Manual Practitioners it is important to recognize that it is always possible to take care of multiple issues with the same movement when using the long lever. An example would be an anterior talus and anterior fibular head can be dealt with at the same time by using the foot. While doing this Post Isometric Relaxation/Reciprocal Inhibition/Respiratory Assistance/Ligamentous Articular Strain/Oscillation are all directly and easily available for both structures without any change in the position of the patient or Operator.
A final consideration of the benefit of the long lever is that the
Operator can do more with less input. As important as patients are the Operator always has to ensure that they do not harm themselves in the process of helping patients. If the Operator is always wrestling with patients and exhausting themselves they won’t be able to help very many people and they will burn out fast. Short lever techniques have their place but the long lever is more effective for the patient and the Operator in most cases.