Whole-Person Health: An Integrated Approach to Musculoskeletal Health

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A Whole Person Approach is Shift away from the primarily tissue focused approach to one that looks at the health of the whole system.

Whole-Person Health: An Integrated Approach to Musculoskeletal Health

Moving Beyond Reductionism: A Whole-Person View

For thousands of years, people around the globe have utilized massage to address a wide range of health issues. Early healing traditions were often rooted in an ecological understanding of health and well-being. These traditions viewed the body as an ecosystem in delicate balance with its surroundings, constantly interacting with the environment and influenced by the natural world.

In musculoskeletal health today, modern medicine often defaults to reductionist, disease-centric models. These models often treat conditions in isolation, frequently overlooking the complex interplay of biological, psychological, social, and environmental factors. A paradigm shift toward Whole-Person Health necessitates a more holistic approach, deeply rooted in the principles of complexity science.

Complexity Science: A Lens for Musculoskeletal Health

Complexity science studies systems with numerous interconnected parts. It provides a useful framework for understanding musculoskeletal health by highlighting the non-linear relationships and interconnectedness of factors that influence health outcomes.

When we treat people with persistent musculoskeletal conditions—such as low back pain or osteoarthritis—we often realize that a "quick fix" fails because the condition is maintained by a complex interplay of factors. By "zooming out," we can ask the right questions:

  • What are the underlying interconnected issues?

  • Are there leverage points where a minor change can produce significant, disproportionate changes across the whole system?

Health, Well-Being, and Complex Systems

"Musculoskeletal conditions" is a broad term for problems affecting muscles, bones, joints, tendons, ligaments, and nerves (e.g., back pain, neck pain, arthritis, repetitive strain injuries). These conditions can be conceptualized as complex networks of interacting symptoms, such as pain, stiffness, poor sleep, and decreased activity.

The wide range of clinical presentation seen in individuals underscores the complex etiology of musculoskeletal conditions, which involves genetic, metabolic, biomechanical, and environmental factors (Cholewicki, et al., 2025).

Symptoms as Interconnected Nodes

Imagine each symptom as a "node" in a network. These nodes are not isolated; they are interconnected. For example, chronic pain can lead to poor sleep, which in turn reduces physical activity. Reduced activity can cause muscle weakness and greater stiffness, further worsening the pain.

Pharmacological and non-pharmacological treatments alter network dynamics, thereby disrupting the self-reinforcing cycle of interconnected symptoms.

The effects of an intervention cannot be explained by a single mechanism. Instead, it acts through a complex interplay of interconnected responses. This aligns with the concept of a "whole-person approach," which emphasizes the interconnectedness of biological, psychological, and social factors that contribute to our overall health and well-being.

Allostatic Load and Resilience

Health and well-being are emergent properties of these interactions, not just the sum of individual symptoms (Cohen et al., 2025). The body's capacity to maintain stability when facing chronic stressors is known as resilience. The "ball and cup" analogy is often used to illustrate this:

  • A deeper cup represents greater resilience, making the system less likely to be pushed past a tipping point into a dysfunctional, chronic state.

  • External and internal factors (e.g., trauma, systemic inflammation, poor sleep, depression, stress, anxiety) act as perturbations that nudge the system toward its tipping point (Lutke Schipholt et al., 2024; Gerard et al., 2024; Klyne et al., 2021).

The Whole-Person Health framework emphasizes an adaptability-focused approach to therapy (Pitcher et al., 2023). When an individual faces chronic stressors, the cumulative wear-and-tear is known as allostatic load. This load diminishes the body's natural resilience, contributing to the emergence and maintenance of chronic pain and musculoskeletal conditions. A key contributor to this is dysregulated neural-endocrine-immune responses (Chapman et al., 2008).

Key Idea: This approach views the system as a whole—where the whole is greater than the sum of its isolated parts—by recognizing how biological, psychological, social, and environmental factors are intertwined.

The 'ball and cup' analogy provides one of the clearest visuals to help understand how complex systems maintain stability and how they transition into new states. A complex system's stability is linked to the depth of the basin. Building resilience (the dashed line) in a system makes it less likely to be pushed past a tipping point into a dysfunctional state. Perturbations that may push the system towards its tipping point include trauma, systemic inflammation, physical inactivity, poor sleep, and psychological factors (such as depression, stress and anxiety symptoms).

Fostering Adaptability and Resilience

A complex systems approach informs the development of multidisciplinary strategies that aim to shift individuals toward a more resilient state. These treatments alter network dynamics through interconnected physiological, psychological, and social processes. Strategies that support lifestyle factors—such as sleep, stress management, nutrition, and physical activity—can have a profound effect on overall health (Artz et al., 2024; Deenik et al., 2025; Langevin et al., 2024; Nijs et al., 2024).

Multimodal Strategies to Foster Adaptability and Resilience:

Implications for Clinical Practice

Adopting this whole-person approach informs the development of context-specific multidisciplinary strategies that foster adaptability and resilience.

Benefits of a Whole-Person Health Approach:

  • Shift in View: Moving from a reductionist, isolated-symptom view to a dynamic, systems-level understanding of health and well-being.

  • Individualized Care: Tailoring treatment plans to address the specific, unique network of symptoms impacting each individual.

  • Improved Outcomes: Leading to more effective and sustainable improvements in function and well-being.

Key Message

The shift to Whole-Person Health necessitates an ecological understanding of well-being, one that views health as an intricate web of connected systems—not just within the individual body, but also in relation to their environment and social context. Embracing complexity science provides the foundation for comprehensive, evidence-based care.

“A shift toward Whole-Person Health recognizes that well-being isn’t just what’s happening in the body—it’s shaped by our environment, social context, and lived experiences.”

By shifting from a reductionist view to a systems-level view, we can foster adaptability and resilience through dynamic physiological, psychological, and social processes.

Glossary of Terms

  • Active inference: A normative framework that elucidates the neural and cognitive processes underlying sentient behavior, beginning with first principles. This framework posits that perception and action work in concert to minimize a shared functional known as variational free energy.

  • Allostasis: The flexible regulation of physiology, underwriting the maintenance of variables within specified ranges by pre-emptive responses based on current and predicted future physiological states, external environments, and behavioral goals.

  • Allostatic load: The “wear and tear” on the body associated with chronically high levels of stress and arousal.

  • Complex system: A system in which the properties are highly dependent on the interactions of its many parts, possibly involving feedback, cycles, and nonlinearities. In this context, “complex” should not be equated with “complicated.”

  • Critical transition: The point at which a system suddenly jumps from one equilibrium to another.

  • Enactivism: A perspective that emphasizes the active role of an organism in constructing and experiencing the world through its interactions with its environment.

  • Equilibrium: A state of a complex system in which current functioning tends to be maintained despite perturbations occurring over time.

  • Exteroception: Perceptual inference based on sensory signals originating from outside the body (e.g., vision, hearing, touch, taste, smell).

  • Force-based manipulations: The application of mechanical forces to the outside of the body with therapeutic intent. This can include light touch, soft tissue massage, mobilization, cupping, acupuncture, or other needling interventions.

  • Health: A state of physical, mental, and social well-being and not merely the absence of disease and infirmity.

  • Interoception: The processing of sensing and perceiving sensory signals relating to internal bodily states.

  • Musculoskeletal conditions: A broad term for problems that affect muscles, bones, joints, tendons, ligaments, and nerves.

  • Network dynamics: Changes of state in biological networks over time or the propagation of effects due to stimuli or disruptions; crucial for understanding disease progression and the impact of therapeutic interventions.

  • Neuroplasticity: Changes in neural pathways and synapses that result from bodily injury or changes in behavior, environment, or neural processes. This reflects the concept that the brain is a dynamic organ that constantly changes in response to internal and external events.

  • Non-linearity: A relationship where outputs are not always proportional to inputs. Small changes may lead to large changes in the system and vice versa.

  • Perturbation: An external factor that potentially interferes with the system’s behavior.

  • Resilience: A system's capacity to recover, grow, adapt, or resist perturbation from a challenge or stressor.

  • Salutogenesis: The process by which individuals move from a less healthy state to a healthier state. The concept emphasizes factors that promote and maintain good health rather than focusing solely on pathogenesis (disease).

  • Whole-person health: Involves examining interconnections among all organs and systems of the body, as well as the effects of multicomponent interventions across physiological, behavioral, social, and environmental domains.

References and Sources

With over 15 years of clinical experience and extensive study of massage therapy research, I'm committed to creating resources that foster the professional development of massage therapists globally. Whether you're a seasoned massage therapist or a curious newcomer, this massage therapy glossary is here to be your one-stop shop for understanding terms as it relates to massage therapy. Additionally this post highlights a substantial body of evidence supporting the use of massage therapy in alleviating pain and enhancing quality of life across a range of health issues.

This is a selection of sources I used to help formulate my ideas based on over-lapping concepts from massage therapy, physiotherapy, chiropractic, osteopathy, lifestyle medicine and traditional healing approaches.

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