The Hand In Front Of The Face

Moving my practice to Saratoga last year has been a blessing, but initially I struggled to decide whether or not to close down my Gloversville practice (that I owned for 10 years). I tried for a while to do both, but my heart was telling me to put all my efforts in Saratoga. Now my Saratoga practice has been growing and I am so grateful for the opportunity to help new patients. I am trained in the McKenzie Method. The McKenzie Method is a well-recognized “technique” for treating back and neck pain. After receiving my diploma from the McKenzie Institute, I worked with a spine surgeon in Virginia. These experiences really taught me a lot about myself and about therapy, but one of the best lessons I remember was in the McKenzie Diploma program. We had an exceptional instructor and he was always coming up with ways to help drive the message home so we wouldn’t ever forget it. On this particular day we were asked to put our hands in front of our faces and to spread our fingers apart just enough to see but also somewhat obscured (You can try this too!). Next we were asked to notice everything in the room. Look at the walls, the people, the furniture, etc. Then to really focus in on one particular thing, let’s say a painting or picture on the wall. Finally we were asked to, “Describe everything we see.” My classmates and I described in detail what we saw. The descriptions varied of course with some that were clearer than others. He would ask some to be more clear and specific and he did this with his questions. So I took the lesson to be that the questions we asked “painted the pictures” we would see. It is very important in my profession to ask open-ended questions and then follow ups for clarification but avoiding leading questions. So, feeling satisfied with myself, thinking I understood the lesson, our instructor asked us why no one described the hand in front of our faces! I was blown away. Remember we were to “describe everything we see.” But none of us described the most obvious thing we saw. We had literally missed the hand in front of our faces. It may sound simplistic, but I have focused much of my career on this practice. I try very hard to see the obvious solutions to the patient’s problems. I often find that, as a society, and especially with the Internet guiding our self-diagnosis, we can miss the obvious and often-simple solution to the problems we are facing. It would be nice if things were always easy to figure out, like the hand in front of our face, but often there is more going on. But I guess my point would be to make sure we first start with the hand in front of our face and if that does not work out then dig deeper. I would like to give an example from my past. I had a patient, when I was in Virginia, who came to me with lower back pain that was affecting his ability to sit more than 5-10 minutes at a time. He was an older man with several medical issues that limited what he was able to do. The surgeon I worked with sent him to me with the words of encouragement, “I doubt there is anything you can do for him, but give it a try.” Of course for my ego this sounded like a challenge and I love a good challenge. So when the patient came into my evaluation room I was determined to “fix” him. I asked all the good questions we are taught to ask and did a very thorough evaluation to make sure I had all the information I could possibly gather to get it right. The patient was frustrated and felt like he was not getting the help he wanted, and he said something to me that, for whatever reason, hit me between the eyes and a light bulb went on. He said, “My main problem is sitting.” He said that if I could just help him figure out how to sit better he would be happy. This was the hand in front of the face. I had been looking at everything except what it was that mattered to him, and I was looking at what “I” wanted it to be so I could help him. Fortunately when I heard that, I stopped and said, “Well, a good place to start would be your posture while sitting.” So I taught him how to use a lumbar roll (I am old enough to remember when lumbar supports were not as common as they are now and convincing people to use them was difficult at times). Anyway, I gave him a roll and sent him on his way. He came back a few days later with a big smile on his face and told me that the roll was a “miracle.” He told me it felt so good that he actually strapped the roll to his back so wherever he went he would have it. And he literally came into my office with the roll on his back. Sometimes the easiest and most simple solution is the best one. I do realize that it is not always this easy and it doesn’t work for everyone, but I believe that we should always start with the hand in front of our face. I have had tremendous results through the years using his mentality. Each week I have patients who come in to me and I consider it my job to help them figure out what is going on and to hopefully offer solutions to their impairments. But there are times of course where there is more to it than just correcting someone’s posture and sending them with a lumbar roll. As the years have gone on I find that although I continue to learn new things, I tend to go back to the basics again and again. When I say basics I don’t mean simple always, but I do mean that the diagnosis should stand up to scrutiny. For me, the patient has all the answers and it is my job to ask the questions that will uncover what is really going on. My instructor would tell us, “We come to a conclusion when we are tired of asking questions.” I enjoy figuring out the puzzle, but at the same time I think I really do like it as much or more when the solution is so obvious it’s easy to figure out…like the hand in front of the face. For those out there that are discouraged, rest assured there is likely a solution and maybe all that has happened is that you are looking at everything “out there” and the thing you are missing is the hand in front of your face! I am always ready to help when/where I can!