When Dr Ruth Hardman MACP talks about her career it is with a kind of humility that belies her impact. 

‘I don’t feel like my career has been very planned out,’ she says. ‘Each time I moved, I felt it was the right time to move on and make a change.’ 

Beneath her modesty lies a powerful story of insight, professional evolution and a commitment to health equity, particularly in rural Australia.

Now living and working in Mildura, located along the banks of the Murray River about 550 kilometres from Melbourne, Ruth is the lead clinician for Sunraysia Community Health Services’ (SCHS) pain rehabilitation service and a postdoctoral researcher supported by La Trobe Rural Health School. 

Ruth is also an APA Titled Pain Physiotherapist, and her dual role reflects a lifelong drive to support people living with persistent pain and chronic illness—especially those with the fewest resources and the most complex challenges.

Ruth’s journey into physiotherapy began early. Born in the UK but raised in the coastal town of Victor Harbor in South Australia, she was drawn to medicine from a young age. 

This interest was somewhat influenced by her father’s disability and her family’s experience with a rare genetic condition called Freeman-Sheldon syndrome.

Graduating at just 19 from what is now the University of South Australia, Ruth admits she was ‘far too young’ for the emotional and psychological complexity of the field she would later embrace. 

‘I didn’t have any concept of what I was dealing with,’ Ruth says. 

After 18 months working as a new graduate physiotherapist at Modbury Hospital, Ruth made a dramatic pivot. 

She left the profession to work backstage as a stage production manager in live theatre, drawing on her experience in youth theatre.

That detour lasted several years, including national tours of Australia and backpacking adventures overseas. But it was in the UK in the early 1990s that Ruth’s path took a decisive turn. 

With jobs in theatre scarce, Ruth returned to physiotherapy for financial reasons but quickly rediscovered a deeper professional purpose. 

Landing a position at Heatherwood Hospital near London, Ruth found herself in the middle of a revolution in evidence-based medicine and the emerging field of pain management.

Ruth with her children in 1999 in the UK.

Ruth gravitated towards the patients whom others found ‘difficult’— those with complex, persistent pain that didn’t respond to standard treatment. 

‘I got bored with people who got better quickly,’ Ruth says. 

Instead, she was energised by the challenge of treating patients whose pain had no simple biomedical explanation.

At Heatherwood Hospital—and later, while studying philosophy at the University of Reading—Ruth began developing a holistic
framework that would underpin her future work. 

Pain, she came to believe, could not be understood in isolation. 

‘Pain is complex. It’s a mind–body relationship. It’s contextual,’ Ruth says. 

‘You can’t look at someone’s persistent pain without looking at the whole picture of their life.’ 

Reading was also the setting for another monumental moment in Ruth’s life; it was where she first met her husband Phil.

Ruth’s mind–body philosophy eventually led her to undertake a master’s degree in pain management through the University of Sydney, followed by a Master of Public Health at Flinders University. 

These postgraduate studies reflected Ruth’s growing interest in the social determinants of health and in why some people thrive despite chronic illness whereas others do not.

Ruth and Phil, who both had the experience of growing up in the country, returned to Australia in 1999 with their young children, then aged three and five. 

The family settled in Adelaide due to some family connections of Ruth’s and the desire to avoid big city life. 

After a difficult adjustment period in Adelaide, Ruth found her ‘spiritual home’ at the Complex Injury Group, a multidisciplinary pain service led by physician Dr Graham Wright. 

The team’s respectful, holistic approach resonated deeply with Ruth, especially as she juggled work and parenting two children with disabilities.

The experience cemented Ruth’s belief that effective healthcare must accommodate the complex realities of people’s lives. 

‘I was going to physios for my daughter and they’d give me this list of things to do,’ Ruth says. 

‘And I thought, if I can just get her to school, that’s a good day.’ 

It was around this time that Ruth became a member of the APA and began consolidating a philosophical foundation.

When Phil accepted a role in Mildura in 2014, the timing felt right for the family to up and move almost 440 kilometres away.

‘Once again, I was ready to move on,’ Ruth says. 

Mildura’s rural setting— with its health inequities and limited resources—would become the ideal testing ground for Ruth’s growing vision of socially responsive, patient-centred care.

Ruth initially thought she’d have ‘a little break’ from working when the family first arrived in Mildura. 

However, when she reached out to SCHS she discovered that they had just received funding to begin operating a pain service but had no idea how to do it. Fortuitously, Ruth did.

‘I said, “I could probably help you with that,”’ she recalls. 

What followed was a rare opportunity: the chance to design a community-based pain rehabilitation service from the ground up.

With a clear focus on equity, the service at SCHS prioritises care coordination and client support over traditional clinical interventions. 

‘We really focus on what the client’s priorities are,’ Ruth says. ‘That may look like a traditional physio intervention or it might look quite different.’

This rural model reflects Ruth’s belief that people with a low socio-economic status, limited education and complex life demands are often poorly served by mainstream health systems. 

‘We expect people to perform in ways they can’t. 

'It’s not that these patients don’t care; it’s that the system isn’t set up for their lives,’ she says.

In 2018 Ruth began a PhD through La Trobe University, investigating how people with multi-morbidity and psychosocial complexity in rural areas engage or struggle to engage with chronic illness self-management. 

‘I kept seeing that even in pain services, some people did well and others didn’t. 

'And it wasn’t about motivation—it was about circumstances,’ she explains.

Her research examined how healthcare delivery models can better support those facing multiple disadvantages, especially in rural settings.

Since completing her doctorate in 2021, Ruth has continued to work as a clinician–researcher. She splits her time between SCHS and the La Trobe Rural Health School, where she is working on two pilot studies. 

One study focuses on care coordination and another explores community paramedicine, a model that stations paramedics in libraries and other community spaces to offer drop-in health support. 

‘Paramedics are the only health workforce in oversupply right now,’ Ruth says. 

‘We need to think creatively, particularly in rural areas.’

The challenges facing rural communities are many, Ruth points out. There are GP shortages, long distances to specialists, limited public transport options and patchy digital infrastructure, for starters. 

From Mildura, the nearest major hospital is in Adelaide, a four-and-a-half-hour drive away.

‘Telehealth has helped but it’s not a magic bullet,’ Ruth says. 

Older adults and those with low digital literacy struggle to use it. Even more significantly, trust is a barrier, she says. 

Many of the people Ruth sees have previously been dismissed or invalidated by the healthcare system. 

‘Pain is a signal that you’re unsafe,’ she says. ‘If you’re being dismissed, you feel even less safe.’

Ruth and the pain rehab team at Sunraysia Community Health Services.

Building trust then becomes foundational. It’s why coordination of care and face-to-face connections are central to Ruth’s service
model. 

‘If people trust the provider, they start to engage and that’s when the magic happens,’ she says.

Ruth’s work has begun to attract national attention. This year she presented at the Rural Workforce Agency Victoria Conference
in February in Bendigo and at the Australian Pain Society’s 45th annual scientific meeting in Melbourne in April. 

Her talks explored how new models, such as community paramedicine, can bridge rural healthcare gaps and why pain management strategies must be tailored to rural realities. 

Ruth has also contributed to the Scope of Practice Review led by Professor Mark Cormack, which calls for broader recognition of allied health practitioners’ capabilities, especially in underserviced areas.

‘It’s crazy that a physio can refer for an ultrasound but the patient has to pay more than if they went through a GP,’ Ruth says. 

‘In rural settings, we need to use the staff we’ve got. That means being flexible and changing the funding models to match reality.’

Ruth credits her parents, both devout Christians, with instilling in her a strong sense of fairness and justice. 

Though she doesn’t identify as religious today, Ruth says those values continue to guide her work. 

Her lived experiences—as a daughter, a mother and a woman in rural health—have given her insight into how people find meaning, even in hardship. 

For Ruth, rural health isn’t just a career choice. It’s a calling. 

In Mildura she is helping to reshape what is possible for people living with pain and complexity in places where healthcare is often hardest to access.

COURSE OF INTEREST: 2025 eTalk #2—Rural physiotherapy: skills and capabilities of rural practitioners