Sensory Processing: Why “Sensitivity” Isn’t a Deficit
Part 5 of my series 'Exploring Neurodiversity in MSK Practice
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Why I’m Writing This Series (in brief)
If you work with people, understanding human diversity — in how we think, feel, sense, move, and communicate — can fundamentally change how you practise.
At its heart, this series is about becoming more neuroaffirmative: not just improving care for neurodivergent clients, but making clinical work more humane, accessible, and sustainable for everyone.
In Part 1, we explored paradigms; in Part 2, disability and environment; in Part 3, ecological diversity; and in Part 4, communication through the Double Empathy Problem.
Part 5 turns to something even more foundational: sensory processing.
Because before communication, before behaviour, before decision‑making…
there is sensation.
And if we misunderstand sensation, we misunderstand everything that follows.
1. The Problem With “Sensory Sensitivity”
In clinical settings, sensory differences are often framed as problems:
“over‑sensitive”
“under‑responsive”
“seeking input”
“defensive”
These labels can be useful descriptively, but they often carry an implicit assumption:
That there is a ‘normal’ way to sense the world — and deviations from it are deficits.
From a neurodiversity perspective, this assumption doesn’t hold.1,2
Instead, sensory differences can be understood as variations in how nervous systems predict, filter, and respond to the world.3
Not better or worse — just different.
And crucially, whether those differences become disabling depends heavily on context.1
It’s also one of the core ideas I’ll be exploring in more depth in an upcoming live session for The Unbound Project on July 14th, 9:00am (BST / UK time). The live Zoom session will be looking specifically at how these same dynamics play out not just with clients, but within MSK teams: how we communicate, collaborate, and work together under pressure.
2. A Quick Clinical Model: Dunn’s Sensory Processing Framework
Dunn’s model remains a helpful starting point for clinicians.4
It describes sensory processing along two interacting dimensions:
Neurological thresholds (high vs low)
Self‑regulation strategies (active vs passive)
This gives us four broad patterns:4
High threshold + passive → misses input (“low registration”)
High threshold + active → seeks input (“sensory seeking”)
Low threshold + passive → overwhelmed (“sensory sensitivity”)
Low threshold + active → avoids input (“sensory avoiding”)
This model is useful because it moves us away from “too sensitive” vs “not sensitive enough”, and towards patterns of interaction between the person and their environment.
But it still raises a deeper question:
Why do these patterns exist in the first place?
3. A Deeper Lens: Predictive Processing and Sensory Worlds
Predictive processing (or active inference) gives us a powerful way to understand sensory differences.3
In simple terms:
The brain is not passively receiving sensory input.
It is actively predicting it.
At any moment, your nervous system is:
generating predictions about what will happen
comparing those predictions to incoming sensory signals
updating its model of the world accordingly3
Perception is therefore not just “input” — it is a negotiation between prediction and sensation.3
Why this matters for neurodiversity
Different nervous systems may:
prioritise prediction and sensory input differently
update predictions at different rates
assign different levels of importance to uncertainty3
This can lead to very different lived experiences:
environments that feel neutral to one person may feel overwhelming to another
subtle bodily signals may be very noticeable for some, and barely noticeable for others
unpredictability may feel mildly uncomfortable for some, profoundly unsafe for others
From this perspective, what we call “sensory sensitivity” might reflect:
a nervous system that assigns high precision (importance) to incoming sensory signals.3
Again, not a deficit.
A different way of organising perception.
4. Sensory Processing in MSK Practice
MSK care is inherently sensory.
We routinely ask clients to tolerate and interpret touch, pressure, movement, position, effort, pain, noise, light, and the presence of others.
For many neurodivergent people, these are not neutral experiences.
They are shaped by:
sensory thresholds4
prediction and uncertainty3
prior experiences (including healthcare)5
current stress load5
What this can look like in practice
A client attends for shoulder pain.
The clinic is bright, with fluorescent lighting
Music is playing quietly
There are multiple conversations happening
The clinician uses hands‑on assessment
Instructions are given verbally and quickly
The client:
becomes less responsive
appears tense
struggles to follow instructions
reports increased pain
This may be interpreted as anxiety, guardedness, or poor engagement.
But through a sensory lens, it may reflect something else:
The sensory environment has exceeded the client’s capacity to predict and regulate input.5
In that state:
communication becomes harder
motor control becomes less efficient
pain becomes more salient
learning becomes more difficult
What looks like a “clinical problem” may actually be a sensory mismatch.
Mismatches are also one of the core ideas I’ll be exploring in more depth in the upcoming session.
5. Interoception: The Hidden Sensory System
We often think of sensation as external — touch, sound, light.
But one of the most important sensory systems in MSK care is interoception:
The perception of internal bodily states.
This includes:
pain
effort
fatigue
hunger
temperature
emotional states6
Interoception varies widely between individuals.6
Some people:
experience internal signals very intensely
find them hard to interpret
struggle to differentiate between sensations
Others may:
have reduced awareness of internal cues
miss early warning signals
find it difficult to gauge effort or load
Why this matters clinically
Many of our core tasks depend on interoception — pacing, load management, pain interpretation, and exercise progression.
If interoception differs, then the way we deliver care needs to adapt.
Otherwise, instructions like:
“work at a comfortable level”
“stop before it gets too sore”
“listen to your body”
may be unclear, inaccessible, or even unhelpful.
6. Sensory Processing and Pain
Pain itself is deeply intertwined with sensory processing and prediction.3,7
From a predictive processing perspective:
Pain can be understood as the brain’s best guess about threat, informed by both sensory input and prior expectations.7
This means that:
unpredictable sensory input can increase perceived threat
overwhelming environments can amplify pain
reduced predictability can reduce tolerance
mismatched expectations can heighten uncertainty3,7
For some neurodivergent individuals:
sensory amplification may increase how noticeable pain feels
interoceptive differences may change how pain is interpreted
environmental noise may compete for attention, increasing distress
prior invalidation may heighten threat predictions
Again, the key point:
Pain is not just about tissue — it is about perception, prediction, and context.
7. From Deficit to Ecology
Across this series, a consistent theme has emerged:
People don’t fail environments.
Environments fail to accommodate people.1,2
Sensory processing makes this especially clear.
A person may function well in one context, and struggle in another.
Not because their nervous system has changed, but because:
the sensory demands have changed
the predictability has changed
the fit has changed
This is ecological thinking applied to sensation.
8. What This Means for MSK Clinicians
Sensory awareness invites a shift in how we interpret clinical encounters.
When a client seems overwhelmed, withdrawn, tense, inconsistent, “over‑reactive”, “under‑responsive”
we can begin to ask:
What is the sensory load of this environment?
How predictable is this session?
What assumptions am I making about sensation?
How might this client be experiencing their body right now?
Small changes, big impact
Often, meaningful change doesn’t require complex interventions.
It may involve:
reducing sensory load (lighting, noise, clutter)
increasing predictability (clear structure, previewing steps)
offering choice (position, pace, input type)
using multiple communication formats (verbal + visual)
slowing down transitions
checking in explicitly rather than assuming
These are not “special adjustments”.
They are good ecological design.
And they benefit everyone.
From Understanding to Action
Understanding sensory processing is not about labelling clients.
It’s about recognising that:
Every clinical interaction takes place within a sensory environment.
And that environment shapes perception, communication, pain and outcomes.
The question becomes:
How do we design those environments more intentionally?
This is something I’ll be exploring further in an upcoming live session for The Unbound Project:
‘Exploring Workplace Conversations Through a Neurodiversity Lens’
Rethinking How MSK Teams Talk, Work, and Collaborate
🗓 Tuesday 14 July
🕖 09:00 (BST / UK time)
📍 Live on Zoom
🎟 Free (registration required)
👉 Register here
While this article focuses on sensory processing in clinical care, the same principles apply within teams.
Differences in sensory processing, communication style, pace, and predictability don’t just shape patient interactions — they shape how colleagues:
give feedback
handle pressure
navigate disagreement
experience safety at work.
When these differences are misunderstood, we can see friction, misinterpretation, and burnout.
When they are understood, even small changes in how we structure conversations, meetings, and expectations can make it easier for people to:
contribute
collaborate
perform at their best.
References & Further Reading
1 Milton, D. (2012) “On the Ontological Status of Autism: The Double Empathy Problem.”
2 Chapman, R. (2021). Neurodiversity and the Social Ecology of Mental Functions.
3 Clark, A. (2016). Surfing Uncertainty: Prediction, Action, and the Embodied Mind.
4 Dunn, W. (1997). The Sensory Profile.
5 Botha, M. & Frost, D. (2020). “Extending Minority Stress Theory to Autistic People.”
6 Mahler, K. (2017). Interoception: The Eighth Sensory System.
7 Moseley, G. & Butler, D. (2017). Explain Pain Supercharged.
Looking Ahead
In Part 6, we’ll explore another key piece of the puzzle:
Executive Function — and how it shapes planning, behaviour, and follow‑through in clinical care.
Explore the Full Series
This article is part of my series ‘Exploring Neurodiversity in MSK Practice’, where I unpack key concepts shaping neuroaffirmative clinical work.
👉 You can explore all parts of the series here.
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I need to go back and read the last one as I skipped ahead, but wanted to say I appreciated the audio so I could multitask it.