Nought to ten

Physiotherapy always starts with the same question, and it is a numerical one.

Nought to ten, how much does it hurt. Nought is nothing, ten is the worst pain you have felt in your life. You give a number and that day's session is built on top of it.

I had rotator cuff surgery on my right shoulder in May, by arthroscopy, after two years of pretending it would sort itself out. Four weeks in a sling and twelve prescribed sessions, two a week.

The physiotherapist is called Noêmia and has small, very straight handwriting that I would recognise anywhere today.

I am going to list the twelve numbers, because they tell it better than I do.

Session 1. Eight.

True. Eight is pain that keeps you awake and I had not been sleeping for five weeks.

The first session has no exercise in it. It has measuring. She measured the range with a goniometer, which is a plastic instrument with two arms and a protractor in the middle, and wrote down every angle.

Forty-two degrees of elevation. Normal is a hundred and eighty.

Session 2. Seven.

A lie, downwards. It was still eight, and I said seven because a man of forty-seven is embarrassed to say eight twice in a row.

That is the most common lie and she knows it. Every physiotherapist knows it. What she did was stop asking for the number and start asking something else: "Did you sleep?" I said no and she wrote eight on the notes.

Session 3. Seven.

True, and it was the first time I understood what the session actually was.

Passive mobilisation means you do nothing. You lie down, let the arm go, and somebody else moves your shoulder to its limit and stops one degree short of real pain.

Finding that limit requires her to hold your arm with both hands, one at the wrist and one above the elbow, and to watch your face, because the face tells her before the mouth does.

It is eighteen minutes. Timed, because it is in the prescription.

Session 4. Five.

True, and it was very good news. Five is pain that bothers you and lets you live.

In that session she cleared me for active-assisted work with a stick and I did it on my own for the first time, while she was on the other side of the room with somebody else.

The room has three couches divided by curtains on tracks. With the curtains open it is one room. With them closed it is three narrow cubicles, with the couch taking up nearly all of each.

In session 4 the curtain stayed open the whole time, and I noticed that, which is information about me and not about her.

Session 5. Six.

A lie, upwards. It was four.

I did not plan it. She asked, I was going to say four, and six came out, and I heard my own voice saying six and did not correct it.

Six means no loading can be cleared, that the day is passive mobilisation and manual release, and that the session will be eighteen minutes of hands on me instead of eighteen minutes of me pulling a yellow band.

In forty-seven years I had never once traded the truth for time.

Session 6. Six.

A lie. It was three or four.

Session 7. Five.

A lie, and a calibrated one. I brought it down a point so the number would keep making sense as progress, because notes that do not improve attract the surgeon's attention.

I was managing a graph. That is something a person works out about himself two months later and feel stupid about.

About myofascial release, which is where all of this lives.

After shoulder surgery the muscles around it lock down. Trapezius, pectoral, teres major. The work is undoing that with sustained pressure, and sustained pressure means a thumb or an elbow held on one point for ninety seconds without easing off.

It hurts and it works. Both at once, and the brain has nowhere to file those separately.

It is a state in which you are lying down with no shirt on, on a couch seventy centimetres wide, with another person's body weight resting on you, and your job is to breathe and not flinch away.

Eighteen minutes. Twelve sessions. That comes to three hours and thirty-six minutes.

Session 8. Five.

Session 9. Four.

True, both, because in session 8 she measured again with the goniometer: a hundred and thirty-one degrees of elevation. My body was contradicting my number and I stopped.

Session 10. Three.

Session 11. Two.

True. In that session she cleared loading with a red band and taught me the home programme, which is the sign that discharge is close.

She said it with the ease of somebody delivering good news. I said that was great.

Session 12. Nought.

True. Actually nought. A hundred and seventy-two degrees of elevation, symmetrical strength, no pain on any of the test manoeuvres.

Discharge is a piece of paper. She filled it in, signed it, stamped it with her registration number and handed me the copy for the surgeon. Twenty to seven on a Thursday.

I thanked her, shook her hand with my right hand, which was the operated shoulder, and left.

I came back twenty minutes later because I had left the home programme sheet on the couch, and the clinic shuts at seven, and at ten past seven there was only her, finishing the day's notes at the front desk with the reception lights already off.

From that point I was not her patient. That matters and it is not a pretext. It is the entire condition of the next paragraph, and she was the one who said so first, out loud, before I did.

The couch in cubicle 2 is seventy centimetres wide, height-adjustable by a foot pedal, and it creaks when the curtain is pulled across after the room is empty.

The shoulder came good.

Full range, no pain, equal strength on both sides. I raise my arm above my head about forty times a day and feel absolutely nothing, which was precisely the clinical objective of the twelve sessions.