When a whole person approach really does mean working with all of it
One of the things I love most about my work is that no two people are ever the same.
And sometimes, thinking completely differently is the only way forward…
There are some clients who remind you exactly why rehabilitation can never be reduced to a simple protocol, checklist or exercise sheet.
Recently, I worked with a client who came to see me following another significant surgery linked to longstanding inflammatory arthritis with multiple orthopaedic complaints.
Whilst I was fortunate to gain some of my most significant Rheumatology experience at University College London Hospitals NHS Foundation Trust and learn from some exceptional clinicians, complex inflammatory and multi-joint presentations like this do not walk into private practice every week.
It was clear that the usual way of approaching rehabilitation simply was not going to work.
This client was living with:
- Two fused knees following multiple revision surgeries
- One fused ankle
- One almost fused elbow
- Two total hip replacements
- Spondyloarthritis contributing to persistent neck pain
- Two painful and significantly restricted shoulders
- Breast cancer treatment just 12 months before their latest revision surgery
But the resolve was absolutely there.
Starting with what actually mattered to them
One of the biggest problems in rehabilitation is that goals can become too clinically focused.
It becomes very easy to focus entirely on range of movement measurements, pain scores, strengthening plans and functional assessments without fully considering what actually matters to the individual sitting in front of you.
This client’s goals were incredibly clear.
They wanted to:
- Get in and out of a chair and car more easily
- Manage a shallow step so they could continue attending a regular social gathering with friends
- Lose weight to help reduce the strain on their body and improve overall health management
These are the sorts of goals many people take for granted, but when somebody has this level of physical restriction, every one of those tasks becomes enormously significant.
These goals weren't really about chairs, cars or steps.
They were about independence.
They were about preserving identity, routine and connection with other people.
They were about maintaining quality of life.
When standard rehabilitation approaches are not enough
With complex orthopaedic and rheumatology cases, you cannot always rely on the standard way of doing things. You have to adapt, problem solve, and sometimes you have to get quite creative!
The normal movement patterns or adaptations we might usually rely on simply were not available.
So every part of rehabilitation had to be approached differently.
We worked around restrictions rather than fighting against them, and focused on function rather than perfection:
- Alternative movement strategies
- Pain management alongside functional progression
- Reducing unnecessary strain through positioning and pacing
- Building confidence alongside physical ability
- Small but meaningful environmental adaptations
- Gradually improving tolerance for activity without creating excessive flare-ups
Over time, everything started opening up:
Pain levels reduced significantly.
Movement became easier.
Confidence improved.
They achieved all of the original goals and even managed to get back onto the treadmill to start working towards their secondary but significant weight loss goal.
Rehabilitation is never just physical
But despite all the physical progress, one thing had not improved in the way they expected.
Sleep.
Even though pain had improved and movement was easier, they were still struggling with intrusive thoughts at night and poor sleep quality.
This is where a whole-person approach really mattered.
Because rehabilitation is never just physical.
As the immediate focus on pain, mobility and simply getting through the day reduced, something else became much more apparent.
It became clear that their most recent surgery and hospital experience had been incredibly difficult emotionally.
This client had spent time on a difficult hospital ward where staff were not fully equipped to support the complexity of their needs. The experience had left a significant emotional impact, but during the acute stages of recovery, there had been little opportunity to acknowledge it.
As we talked more, we realised there was a lot more going on beneath the surface:
Fears about the future.
Questions about what further decline might look like.
Concerns about dependence, deterioration and coping long term.
And importantly, there was distress and frustration about the increasing limitations and around how much effort everyday life now required.
Shifting the focus
At that point, rehabilitation needed to shift.
Not away from physical health, but beyond it.
We started having conversations about what the surgery experience meant to them emotionally and psychologically. We discussed their fears, frustrations and uncertainty about the future.
Just acknowledging these feelings had a huge impact.
So often, people with long-term conditions become highly skilled at simply “getting on with it” whilst the emotional burden quietly accumulates in the background.
Once we shifted some of the focus towards their experience as a whole person rather than only looking at joints, pain and movement, things started to change surprisingly quickly.
We introduced some very simple but intentional changes to their daily routine:
- Better morning and evening routines
- Improved sleep hygiene
- Prioritising recovery during the day instead of constantly pushing through fatigue
- Creating more time for rest and mental decompression before bed
- Reducing overstimulation and stress accumulation throughout the day
Within a couple of weeks, their sleep had improved significantly and the intrusive nighttime thoughts had started reducing.
Not because we found some magic solution, but because we created the space to process what they had been through.
Rehabilitation shouldn't stop at “good enough”
One of the things I feel very strongly about is that rehabilitation should not end simply because somebody can complete the basic tasks required to survive day to day.
Being technically independent is not the same as having quality of life.
Now that the original goals have been achieved, we are continuing to build on them. Some are practical, some are social, and some are simply about confidence.
We now work on things like visiting new venues with different access challenges, including places like the cinema, or trying something new each month that previously felt too difficult or overwhelming. The purpose is to build confidence in unfamiliar environments and continue expanding what feels possible for the client.
That is what meaningful rehabilitation looks like - helping people do the things that matter to them.
Why I take a whole person approach
People living with inflammatory arthritis, chronic pain, complex orthopaedic conditions or long-term health challenges are often incredibly used to being treated as a collection of symptoms.
But nobody experiences life that way.
- Pain affects sleep.
- Poor sleep affects mood and energy.
- Fatigue affects confidence.
- Fear affects movement.
- Loss of independence affects emotional wellbeing.
Everything is connected.
That is why my approach to rehabilitation is always centred around the person in front of me, not just their diagnosis.
This whole-person approach matters because without it, we miss the factors that are often most responsible for keeping people stuck.
Looking for rehabilitation that works around real life?
If you are recovering from surgery, living with a chronic condition, managing persistent pain or navigating complex long-term health conditions, rehabilitation should feel personal, practical and realistic.
My approach focuses on helping people improve meaningful function, rebuild confidence and maintain independence in ways that genuinely matter to their everyday lives.
Whether your goal is returning to social activities, managing fatigue more effectively, improving mobility or simply feeling more like yourself again, rehabilitation should support the life you want to live.
Sarah Lord
Physiotherapist, certified coach and health consultant
I’m a physiotherapist, certified coach and health consultant based in Cockermouth with 27 years of experience helping people improve their physical, mental and emotional wellbeing through physiotherapy, coaching and nervous system informed support. My background is in musculoskeletal and orthopaedic physiotherapy, alongside specialist work in stress, recovery, resilience and long-term health.
