The Social Model of Disability: What It Means for MSK Clinical Practice

Part 2 of my series 'Exploring Neurodiversity in MSK Practice'

Why I’m Writing This Series (a short reminder)

Before moving into Part 2 of this series, I want to briefly revisit why I’m writing it.

If you’ve chosen a career helping other human beings, I believe that understanding human diversity — in how people think, feel, sense, move, and communicate — can genuinely transform your practice. It doesn’t replace your clinical knowledge; it expands it. It helps you support your clients more effectively and look after your own wellbeing in the process.

Becoming more neuroaffirmative doesn’t just benefit neurodivergent clients — it improves care for everyone. When we design our clinical environments, communication, and expectations with a wider range of humans in mind, our work becomes more inclusive, more humane, and more sustainable.

We’re living in a time when genuine understanding between people has never been more needed. Division, fear, and misinformation feel increasingly present. Yet the natural world shows us something different: diversity strengthens systems. Biodiversity stabilises ecosystems; neurodiversity strengthens communities.

This series is my attempt to share ideas that have helped me as a clinician, educator, and neurodivergent person — ideas that make MSK practice more compassionate, more accessible, and more effective for all the people we serve.

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In Part 1 of this series, we explored how many of us, as MSK clinicians, have already begun to shift away from structuralist thinking, informed by modern pain science and a growing appreciation of context, meaning, and relationship. We also examined how the Pathology Paradigm tends to locate problems within the individual — whether in their tissues, their behaviour, or their neurotype.

Part 2 builds on that foundation by introducing a key idea in contemporary disability studies: the Social Model of Disability.

For MSK clinicians who want to become more neuroaffirmative, this model is essential. It helps us understand why neurodivergent people often struggle in healthcare settings, and why changing the environment, not the person, is the most effective and humane response. And crucially, when we make our practice more neuroaffirmative, we make it better for everyone.

1. What the Social Model Actually Says

The Social Model of Disability was formulated and named by Mike Oliver in 1983, when he introduced it in his work ‘Social Work with Disabled People’¹. It was later developed further by scholars such as Tom Shakespeare, who critically explored the social model in his 2001 paper ‘The social model of disability: an outdated ideology?’².

The model makes a simple but profound distinction:

• Impairment = the body or mind you have

• Disability = the barriers you encounter in society

In other words, people are not disabled by their bodies or minds — they are disabled by environments, expectations, and systems that fail to accommodate them.

This applies directly to neurodivergent people, whose differences in communication, sensory processing, executive function, and movement are often pathologised simply because they differ from neuromajority norms.

But it also applies to:

• people with chronic pain

• people with hypermobility

• people with trauma histories

• people with fatigue conditions

• people with anxiety or depression

The Social Model is not just for disability studies — it is a practical clinical tool.

2. Why the Social Model Matters for Neuroaffirmative MSK Practice

MSK clinicians already understand that pain is shaped by context. The Social Model extends that logic to disability and neurodiversity.

Here’s what that looks like in practice:

• Sensory overload is not a “patient problem” — it’s an environmental barrier
  Neurodivergent clients often experience sensory input more intensely than neurotypical clients. Bright lights, unpredictable noise, strong smells, crowded waiting rooms, and unexpected touch can disable someone with sensory sensitivity.⁴ The impairment is sensory difference. The disability is the environment. And when we reduce sensory load, neurotypical clients benefit too.

• “Non‑compliance” is often executive load, not lack of motivation
  Neurodivergent clients may struggle with planning, sequencing, remembering, or initiating tasks.⁸ But so do clients with chronic pain, fatigue, depression, or trauma. The impairment is executive function difference. The disability is a system that assumes everyone can self‑organise in the same way. A neuroaffirmative approach — clear steps, predictable routines, visual supports — helps all clients.

• Communication breakdowns are relational, not individual
  As Milton’s Double Empathy Problem³ shows, communication difficulties arise from mismatched neurotypes, not deficits in one party. A neurotypical clinician and a neurodivergent client may simply be using different communication norms. When we adopt neuroaffirmative communication — explicitness, clarity, pacing, predictability — neurotypical clients benefit too.

• Pain behaviours are shaped by context, not just tissues
  Pain science has already taught us this. The Social Model simply applies the same logic to disability and neurodiversity.

3. The Social Model Helps Us See What We’ve Been Missing

When MSK clinicians adopt the Social Model, several things become clearer:

• The environment is not neutral.
  Rooms, processes, communication styles, and expectations all shape outcomes — especially for neurodivergent clients.

• Variation is normal
  Bodies vary. Brains vary. Movement varies. Sensation varies. Communication varies. This variation is not pathology, even when it differs from neuromajority norms.

• Many clinical “problems” are actually mismatches
  Not deficits. Not dysfunctions. Not non‑compliance.
  Just mismatches between the person and the environment.

• Changing the room often changes the outcome
  Literally and metaphorically.

4. What This Looks Like in Real MSK Practice

Below are some examples of how the Social Model can reframe everyday clinical situations. This is not about being ‘soft’; it is about being accurate. It is about being neuroaffirmative:

• Example 1: The “anxious” neurodivergent client
  Traditional view: “Anxiety is the patient’s problem.”
  Social Model view: “What in this environment is unpredictable, overwhelming, or unclear?”⁴

• Example 2: The “non‑compliant” client with ADHD or chronic pain
  Traditional view: “They’re not motivated.”
  Social Model view: “Is the plan too complex? Too vague? Too demanding of executive function?”⁸

• Example 3: The “avoidant” autistic client
  Traditional view: “They’re catastrophising.”
  Social Model view: “Is the sensory load too high? Is the communication unclear? Is the pace too fast?”⁴

• Example 4: The “difficult” client
  Traditional view: “They’re not engaging.”
  Social Model view: “Is the communication style mismatched? Are we assuming shared norms that aren’t shared?”³

5. Why This Matters for Neurodivergent Clients — and for Everyone Else

Neurodivergent people — autistic, ADHD, dyspraxic, dyslexic, Tourette’s, PDA, and others — often experience:

Sensory Overload⁴

• A patient becomes agitated or shuts down during assessment because bright lights, background chatter, and equipment noise are all competing

• They struggle to follow instructions during an exercise class in a busy gym area

• Manual therapy feels “too intense” even when clinically typical

Communication Mismatches³

• You say “just relax the shoulder” → patient doesn’t respond (instruction too vague)

• Patient gives very detailed, literal descriptions but struggles with open questions like “how does it feel overall?”

• You interpret limited eye contact as disengagement; they’re actually concentrating
  

Executive Function Challenges⁸

• Patient agrees to a rehab programme but forgets exercises / can’t get started / struggles to sequence steps correctly

• Repeatedly misses appointments or arrives late

• Feels overwhelmed by multi-step home programmes

Interoceptive Differences⁷

• Patient struggles to describe pain location or intensity clearly

• They don’t notice early fatigue → push into flare-ups

• Very intense awareness of small sensations → high distress

• Difficulty linking physical sensations to emotions (e.g. tension vs anxiety)

Masking And Burnout⁹

• Patient appears “coping well” in clinic but later crashes (pain flare, fatigue spike)

• They agree with everything you say but don’t disclose confusion or distress

• High-achieving patient suddenly “drops off” rehab due to overwhelming fatigue

Minority Stress¹⁰

• Patient is hypervigilant or guarded because of past negative healthcare experiences

• Hesitant to disclose neurodivergence or needs

• Chronic stress amplifies pain, tension, and fatigue

• They’ve internalised messages like “I’m difficult” or “I should just cope”

The Social Model of Disability helps clinicians understand that these are not personal failings. They are interactions between a person and an environment that wasn’t designed for them.

Instead of asking “What is wrong with this person?”, we should be asking “What is happening in the environment that is making things harder than it needs to be?”

And here’s the key point:

When we make MSK practice more neuroaffirmative, we make it more humane, more accessible, and more effective for everyone.

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References & Further Reading

¹ Oliver, M. (1983). Social Work with Disabled People.
² Shakespeare, T. (2001). “The social model of disability: an outdated ideology?”
³ Milton, D. (2012/2014+) Double Empathy Problem.
⁴ Dunn, W. (1997). Dunn, W. (1997). The Sensory Profile.
⁵ Chapman, R. (2023). Neurodiversity and the Social Ecology of Mental Health.
⁶ Walker, N. (2021). Neuroqueer Heresies.
⁷ Mahler, K. (2017). Interoception: The Eighth Sensory System.
⁸ Barkley, R. (2012). Executive Functions: What They Are, How They Work, and Why They Evolved.
9 Hull, L. et al. (2017). “Camouflaging in Autism Spectrum Conditions.”
10 Botha, M. & Frost, D. (2020). “Extending Minority Stress Theory to Autistic People.”

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Future parts of this series

This article is the second in a series titled ‘Exploring Neurodiversity in MSK Practice’. I am releasing the series in the lead-up to my presentation at this year’s Therapy Show (26 November 2026, Birmingham NEC) — ‘Changing the Room, not the Person: Neurodiversity and MSK clinical Practice’.

In each article, I aim to unpack a key concept, grounded in the work of its originating scholars. At the time of writing, I plan to explore the following areas in greater detail:

• The Pathology Paradigm vs the Neurodiversity Paradigm

• The Social Model of Disability (this article)

• Ecological Diversity & Neurodiversity

• The Double Empathy Problem

• Sensory Processing

• Executive Function

• Communication Across Neurotypes

• Masking & Burnout

• Co‑Regulation & Safety

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