Body Awareness, Participation, and Neurodiversity: Exploring the Potential of Massage and Lymphatic Therapy

Understanding Neurodivergence, Interoception, and Supportive Body-Based Approaches

Neurodivergence describes natural variations in how people think, learn, communicate, process sensory information, and experience the world. The neurodiversity paradigm recognises these differences as part of normal human diversity rather than deficits requiring correction. From this perspective, wellbeing is enhanced not by encouraging conformity to neurotypical norms but by creating environments and supports that allow individuals to thrive according to their own needs, preferences, and goals (Botha & Frost, 2020).

While neurodivergent individuals possess diverse strengths and capabilities, many encounter barriers within systems and environments not designed with neurodiversity in mind. Sensory overload, unpredictable demands, inaccessible workplaces, social expectations, and a lack of appropriate accommodations can contribute to stress, fatigue, reduced participation, and burnout (Raymaker et al., 2020).

Occupational Participation and Wellbeing

Occupational participation: engaging in meaningful activities such as work, education, relationships, self-care, leisure, and community life is closely linked to health and wellbeing. For neurodivergent individuals, participation is shaped not only by personal factors but also by the accessibility and flexibility of their environments (American Occupational Therapy Association [AOTA], 2020).

Research highlights the significant impact of chronic stress and autistic burnout on daily functioning and quality of life. Autistic burnout is characterised by persistent exhaustion, increased sensory sensitivity, reduced tolerance for demands, and loss of functional capacity following prolonged exposure to stress and unmet support needs (Raymaker et al., 2020).

Supporting participation therefore requires approaches that promote self-understanding, energy management, environmental adaptation, and meaningful engagement rather than focusing solely on symptom reduction.

Interoception: Understanding Internal Body Signals

Interoception refers to the perception and interpretation of internal bodily signals, such as hunger, thirst, temperature, breathing, heart rate, pain, muscle tension, fatigue, and emotional arousal (Khalsa et al., 2018).

Many neurodivergent individuals experience differences in interoceptive processing, which may influence emotional awareness, self-regulation, sensory experiences, recognition of physical needs, and responses to stress (DuBois et al., 2016).

Interoception is increasingly recognised as a key component of wellbeing because it helps individuals understand and respond to their body’s needs. Difficulties identifying internal signals can contribute to delayed recognition of hunger, challenges in noticing escalating stress, difficulty interpreting emotions, or uncertainty about bodily sensations (Mahler, 2022).

Importantly, interoceptive differences should not be seen as deficits. They represent another dimension of neurodivergent experience that may benefit from supportive and individualised approaches.

Massage Therapy, Affective Touch, and Body Awareness

Massage therapy has been explored as an approach to support body awareness, relaxation, and nervous system regulation. Affective touch, which is slow, gentle, non-threatening touch, activates neural pathways involved in emotional processing, body awareness, and autonomic regulation. This can foster feelings of safety, connection, and relaxation, potentially supporting interoceptive awareness and emotional wellbeing (McGlone et al., 2014).

For neurodivergent individuals who find touch comfortable and regulating, massage therapy may help develop awareness of muscle tension, breathing patterns, stress responses, and other internal bodily signals. Enhanced body awareness may support self-advocacy, emotional regulation, and recognition of personal needs. However, touch preferences vary widely, and massage should always be adapted to individual sensory preferences, comfort, and consent.

I spoke at length with Sarah-Jane Carr of SJ Body Contour, who has over ten years of experience in post-operative care, lymphatic therapy, and advanced body contouring. She described the benefits of lymphatic massage and its connection to interoception.

The lymphatic system communicates with the nervous system through chemical and immune signalling, relaying information about internal states such as inflammation, hydration, and metabolic health, which directly shape our conscious and subconscious bodily awareness (Zhao et al., 2024).

Sarah told me about the real-world impact of her service, and those like it, providing and demonstrating how this impacts an individual's physiological state,

"Many of my neurodivergent clients experience stress, anxiety and disconnection from their body. Often, they tell me that lymphatic massage has been more beneficial than traditional massage"

The Potential Role of Lymphatic Drainage

Manual lymphatic drainage (MLD) is a gentle, specialised form of massage traditionally used to support lymphatic circulation and manage conditions associated with lymphatic dysfunction. Research demonstrates its benefits in reducing swelling, promoting relaxation, and improving wellbeing across clinical populations (International Society of Lymphology, 2020).

While research specifically examining MLD in neurodivergent adults is limited, its gentle, rhythmic nature may provide calming sensory input, support relaxation, and encourage greater bodily awareness. In addition, for many clients, lying on their back (supine) rather than on their front (prone) may also allow them to feel 'less trapped' and could lower their fight-or-flight response, providing a greater feeling of control and comfort.

Inflammation, Stress, and Whole-Person Health

Inflammation is a natural biological process essential for healing and immune function. Chronic stress and persistent inflammation, however, are linked to poorer physical and mental health outcomes. Emerging research suggests interactions between immune, autonomic, and inflammatory processes and neurodevelopmental differences, though these relationships remain complex. Importantly, inflammation does not cause neurodivergence; rather, it may influence overall wellbeing, energy, pain, fatigue, and stress responses (Eccles et al., 2023).

For many neurodivergent individuals, factors such as chronic stress, inadequate recovery, sleep disruption, pain, and co-occurring health conditions can place extra demands on the nervous system and affect participation in daily life.

Emerging Connections: Neurodivergence, Hypermobility, Autonomic Regulation, and Interoception

Research is exploring links between neurodivergence, connective tissue differences, hypermobility, autonomic regulation, chronic pain, and interoception (Csecs et al., 2022). Conditions such as hypermobile Ehlers-Danlos syndrome, postural orthostatic tachycardia syndrome (POTS), endometriosis, and Polyendocrine Metabolic Ovarian Syndrome (PMOS) formally polycystic ovary syndrome (PCOS) often involve pain, fatigue, autonomic dysregulation, and altered body awareness. These overlapping conditions may further shape interoceptive processing and bodily awareness.

Although this field is still developing, it highlights the importance of holistic approaches that consider physical health, sensory processing, emotional wellbeing, and participation as interconnected aspects of human experience. 

Supporting Self-Management and Participation

Many neurodivergent individuals develop highly effective strategies to navigate daily demands while maintaining wellbeing. These may include:

• Energy accounting and pacing

• Sensory planning and environmental modification

• Flexible routines and scheduling

• Rest and recovery practices

• Movement and physical activity

• Sleep support strategies

• Interoceptive awareness practices

• Access to appropriate accommodations and supports

Occupational therapists often collaborate with individuals to identify personalised strategies that support participation in meaningful activities while respecting neurodivergent ways of being (AOTA, 2020). Massage therapists and lymphatic practitioners can also contribute by providing supportive environments that foster relaxation, body awareness, and self-understanding within a broader interdisciplinary approach.

A Collaborative and Neurodiversity-Affirming Approach

It is important to state that we do not view neurodivergence as something to be treated, but rather we seek to understand how an individual's differences impact them, what strengths the individual has, and what supports they may need.

Neurodiversity-affirming practice recognises that wellbeing is achieved not by changing neurodivergent traits but by reducing barriers, supporting autonomy, and enabling meaningful participation. Lived experience, individual preferences, and collaborative decision-making are central.

Within this framework, massage therapy and lymphatic drainage are optional supportive tools that may enhance comfort, relaxation, and body awareness for some individuals. Their value lies not in “normalising” neurodivergent people but in supporting self-determined wellbeing and participation.

Conclusion

Interoception, autonomic regulation, and body awareness are emerging areas of interest in neurodivergent health research. While direct evidence for lymphatic drainage in neurodivergent populations is limited, massage therapy and MLD may offer supportive benefits related to relaxation, sensory regulation, and awareness of internal bodily states.

When integrated within a neurodiversity-affirming, person-centred framework, these approaches may complement broader self-management strategies that support wellbeing, participation, and quality of life.

Continued research will deepen understanding of the connections between body awareness, nervous system regulation, and meaningful participation, enabling practitioners to better support neurodivergent individuals in ways that honour their strengths, preferences, and lived experiences.

Disclaimer

Body Awareness, Participation, and Neurodiversity: Exploring the Potential of Massage and Lymphatic Therapy.

This article is for educational purposes and should not be interpreted as medical advice or endorsement.

Lymphatic drainage and massage therapy are complementary wellbeing approaches and are not 'treatments' for any form of neurodivergence.

Individuals should consult qualified healthcare professionals regarding their specific circumstances.

References

American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2), 7412410010. https://doi.org/10.5014/ajot.2020.74S2001

Botha, M., & Frost, D. M. (2020). Extending the minority stress model to understand mental health problems experienced by autistic people. Society and Mental Health, 10(1), 20–34. https://doi.org/10.1177/2156869318804297

Csecs, J. L., Iodice, V., Rae, C. L., & Critchley, H. D. (2022). Joint hypermobility links neurodivergence to dysautonomia and pain. Frontiers in Psychiatry, 13, 786916. https://doi.org/10.3389/fpsyt.2022.786916

DuBois, D., Ameis, S. H., Lai, M.-C., Casanova, M. F., & Desarkar, P. (2016). Interoception in autism spectrum disorder: A review. International Journal of Developmental Neuroscience, 52, 104–111. https://doi.org/10.1016/j.ijdevneu.2016.05.001

Eccles, J. A., Owens, A. P., Mathias, C. J., Umeda, S., & Critchley, H. D. (2023). Interoception and autonomic regulation across physical and mental health conditions. Frontiers in Psychiatry, 14, 1182712. https://doi.org/10.3389/fpsyt.2023.1182712

International Society of Lymphology. (2020). The diagnosis and treatment of peripheral lymphedema: 2020 consensus document. Lymphology, 53(1), 3–19.

Khalsa, S. S., Adolphs, R., Cameron, O. G., et al. (2018). Interoception and mental health: A roadmap. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 3(6), 501–513. https://doi.org/10.1016/j.bpsc.2017.12.004

Mahler, K. (2022). The interoception curriculum: A guide to developing mindful self-regulation (2nd ed.). AAPC Publishing.

McGlone, F., Wessberg, J., & Olausson, H. (2014). Discriminative and affective touch: Sensing and feeling. Neuron, 82(4), 737–755. https://doi.org/10.1016/j.neuron.2014.05.001

Raymaker, D. M., Teo, A. R., Steckler, N. A., et al. (2020). Having all of your internal resources exhausted beyond measure and being left with no clean-up crew: Defining autistic burnout. Autism in Adulthood, 2(2), 132–143. https://doi.org/10.1089/aut.2019.0079

Zhao, H., Sun, M., Zhang, Y., et al. (2024). Connecting the dots: The cerebral lymphatic system as a bridge between the central nervous system and peripheral system in health and disease. Aging and Disease, 15(1), 115–152. https://doi.org/10.14336/AD.2023.0516