Why an Old Ankle Sprain Can Still Shape Your Body: The Lasting Effects of Foot & Ankle Nociception on Movement, Compensation and Pain
When most people think of an ankle sprain, they imagine an acute injury, a few days of swelling and pain, and then a gradual return to normal function. But for a surprisingly large proportion of people, that’s not the end of the story. Decades after that “minor” sprain, subtle lingering changes in how the nervous system processes inputs from the foot and ankle can continue to drive altered movement patterns, compensation, and patterns of pain — long after the tissues appear healed on imaging. The key to understanding this lies in the role of nociception — the body’s system of “threat receptors” — and how persistent nociceptive signalling reshapes motor control and neural organisation.
What Is Nociception, and Why Does It Matter?
Nociception is the physiological process by which specialised sensory neurons (nociceptors) detect potentially damaging mechanical, thermal, or chemical stimuli and send signals to the spinal cord and brain. These are not “pain receptors” in a simplistic sense; rather, they are threat detectors that alert the nervous system to possible harm. When activated, these receptors trigger defensive responses and behavioural changes designed to protect the tissue from further injury.
Importantly, the perception of pain and the activation of nociceptors are not the same thing — nociceptors can fire without conscious pain, and pain can be influenced by psychological and contextual factors. This distinction is central to modern pain science and functional neurology because it explains why residual nociceptive signalling can persist and influence the nervous system even when tissue damage is no longer visible.
The Ankle: A Hub of Sensory Input and Motor Control
The anatomy of the foot and ankle is rich with mechanoreceptors and nociceptors that provide the brain with detailed information about joint position, pressure distribution, and limb loading. These sensory signals are essential for balance, proprioception, and coordinated movement. Damage to these receptors — such as occurs with an ankle sprain — disrupts this input and can lead to deficits in proprioception and tactile feedback.
When the normal flow of sensory input from the ankle is compromised, the central nervous system (CNS) adapts. Over time, these adaptations become ingrained in motor patterns and postural strategies.
Residual Nociception and Long-Term Motor Changes
Decades of research increasingly show that even a single significant ankle sprain can have long-term effects:
1. Sensorimotor Deficits Persist Long After the Injury
In people with chronic ankle instability — a common sequela of ankle sprains — researchers have documented deficits in proprioception, postural control, and tactile sensation compared with healthy controls. These sensory-motor changes are not limited to the injured limb but can affect bilateral gait and stability.
This suggests that peripheral disruptions in sensory feedback do not remain “local.” Instead, they trigger widespread changes in how the nervous system organises movement and balance.
2. Altered Gait and Movement Strategies
Studies examining gait in individuals with chronic ankle instability reveal neuromechanical changes — such as altered foot kinematics, changes in ground reaction forces, and compensatory strategies at the knee and hip — compared with people without chronic instability. These patterns often persist even in weight-bearing tasks such as walking.
In other words, the nervous system adopts new “default” strategies and distributes loads differently in an attempt to protect the compromised ankle. Over many years, these strategies can generate compensatory stress and pain elsewhere (e.g., knees, hips, low back).
3. Supraspinal (Brain) Reorganisation
There is evidence that chronic alterations in sensory input from the ankle do more than alter local motor reflexes — they can change supraspinal motor control. Differences in anticipatory postural adjustment patterns and centre-of-pressure dynamics during gait initiation suggest that the brain’s planning and execution of movement shifts after injury.
This is consistent with modern understandings of neuroplasticity — the nervous system reorganises functionally and structurally when sensory experiences change. Over time, such changes can become habitual and self-reinforcing.
Why Old Nociceptive Signals Can Still Matter
Central Sensitisation and Persistent Threat Signalling
A substantial body of pain science research shows that persistent or repeated nociceptive input can lead to central sensitisation, a state in which the CNS remains hyper-responsive to threat signals. This phenomenon amplifies sensory processing and can make benign stimuli feel threatening or painful.
This is important because it means that even subtle, ongoing abnormal input from an old injury site — such as uneven pressure or altered joint mechanics — can sustain a sensitised state. The nervous system continues to interpret signals from the region as “threatening,” maintaining protective responses that restrict movement, increase guarding, and perpetuate compensatory patterns.
Nociception Alters Motor Output
Research indicates that chronic nociceptive activity can actively influence motor output — inhibiting activity of painful or threatened muscles and altering sympathetic nervous system output. This can impair normal movement retraining and reinforce compensations.
In simpler terms, the system “learns” protective postures and movements, which can become engrained and persist even when the original tissue injury has long healed.
Whole-Body Consequences of an Old Ankle Problem
The foot is the foundation of posture and movement. When its sensory input is altered:
Postural balance can be compromised, increasing fall risk and requiring greater reliance on vision and proximal joints for stability.
Compensatory movement patterns may emerge, such as hip dominance in gait or altered knee mechanics, which can load structures in ways they are not optimised for.
Chronic pain patterns can originate in the ankle but be expressed elsewhere, due to maladaptive redistribution of forces and central sensitisation.
These systemic effects reflect the integrated nature of the nervous system: sensory disruptions in one region can ripple out to influence whole-body control.
Clearing Persistent Nociceptive “Threat Signals” Matters
From a functional neuro health perspective, addressing persistent nociceptive signalling is not just about resolving local pain — it’s about resetting how the nervous system interprets and responds to sensory input. This can involve:
Targeted neuromotor engagement to retrain proprioceptive accuracy and motor patterns
Desensitisation and graded exposure rather than avoidance of movement
Addressing central sensitisation with education and nervous system–based strategies
Integrating balance, strength, and coordinated movement into tasks relevant to daily life
The aim is to reduce persistent threat signalling from the old injury site, allowing the CNS to recalibrate and restore functional motor outputs — which can improve pain, movement efficiency, and overall wellbeing.
Conclusion
An old ankle sprain is more than a scar on tissue. It is — in many cases — a remapping of sensation and motor control within the nervous system. Because nociception functions as a threat detector, ongoing or maladaptive signals from the foot/ankle complex can shape how the brain organises posture and movement long after the original injury has healed.
Healing, therefore, is not just tissue repair — it is restoring accurate sensory input, motor control, and balanced nervous system responses. Clearing persistent nociceptive signalling offers the potential not just for local pain relief, but for systemic improvements in movement patterns and quality of life.
How This Is Addressed in Clinic: Turning Down Threat, Restoring Trust
The good news is that persistent nociceptive signalling from an old ankle injury is not permanent. From a functional neurology perspective, the nervous system is always adapting — and with the right inputs, it can be guided to update its threat assessment.
In clinic, this work begins by recognising that the issue is not simply “weakness” or “tightness,” but altered sensory information coming from the foot and ankle. When the brain continues to receive inaccurate or threatening input from this region, it will maintain protective motor strategies, even decades after the original injury has healed.
By reintroducing specific, meaningful sensory input, we can help the nervous system reassess the area. This includes targeted stimulation of the structures that inform joint safety and load tolerance — such as ligaments, joint capsules, and Golgi tendon organs — alongside controlled movement, balance challenges, and proprioceptive tasks. These inputs are not random; they are selected to provide the brain with clearer, more accurate information about position, force, and stability.
From a functional neurology standpoint, the goal is to collapse the perceived threat. As sensory accuracy improves, nociceptive signalling reduces, and the brain receives the message that the area is safe, stable, and capable. When this happens, protective motor patterns begin to unwind naturally — movement becomes smoother, compensation reduces, and pain patterns often change without forcing or aggressive intervention.
This approach is not limited to the ankle. The same principles apply to any old or current injury throughout the body. Wherever the nervous system has learned to stay guarded — whether due to trauma, repeated strain, or unresolved injury — restoring accurate sensory input can help recalibrate threat perception and improve whole-body function.
Ultimately, this work is about restoring trust between the brain and the body. When the nervous system no longer feels the need to protect, it allows the body to move, load, and function as it was designed to — often with profound effects on pain, confidence, and overall wellbeing.
Fear Paralysis Reflex
Fear Paralysis Reflex: The "Big Boss" of Primitive Reflexes
What It Is — And Why It Matters
The Fear Paralysis Reflex (FPR) is the earliest defensive reflex, emerging as early as 5–7 weeks post-conception. Seen as the fetus’s built-in "play possum" mechanism, it triggers a full-body freeze to protect during perceived threats (like maternal stress) by slowing movement, lowering heart rate, and conserving energy
Ideally, FPR integrates in utero, merging into the Moro reflex and ceasing by around 32 weeks But when it doesn’t disintegrate, it lingers—and becomes the "big boss" holding subsequent reflexes in check
From Womb to Dorsal-Vagal Freeze
In polyvagal terms, a retained FPR is tied to the dorsal vagal shutdown—the same survival-state that underpins extreme freeze, dissociation, or vasovagal fainting.
So when FPR is active post-birth, individuals may default to curling up, shutting down, or emotionally disconnecting—like "letting the world pass us by."
Signs of a Retained FPR in Children & Adults
Emotional & Behavioral Traits:
Heightened anxiety, phobias, panic attacks
Extreme shyness or social withdrawal; selective mutism
Freezing under stress; “deer in headlights” responses
Elective mutism or difficulty speaking in unfamiliar settings
Sensory & Physiological Reactivity:
Hypersensitivity to touch, sound, light, movement
Shallow or difficult breathing; fatigue, holding breath
Motion sickness, poor stress tolerance
Cognitive & Social Challenges:
Inflexibility, fear of change, routines dependence
Obsessive-compulsive or perfectionistic tendencies
Difficulty with eye contact, low self-esteem, defensive or oppositional behavior
Mental Health & Developmental Impact:
Withdrawal, depression, isolation
Language delays, especially expressive or social speech
Learning challenges, poor motor control/balance
Why FPR Deserves the "Big Boss" Title
Root of Other Issues: If FPR remains active, it can prevent other primitive reflexes from integrating properly, undermining motor, emotional, and cognitive progress
Deepest Level: It’s the most primal reflex—deeper than Moro—and forms the foundation for survival behavior. When stuck, it locks the system into a baseline fear response
Emotional Filter: It colors every perception through a lens of fear and shutdown, affecting sleep, attachment, exploration, and social engagement
Functional Neuro Health Approach: Integration for Transformation
Polyvagal Framework & Nervous System Regulation Awakening the ventral vagal system (social engagement) is key—to move from shutdown into connection and calm
Profound Benefits of Integration
Once FPR integrates:
Emotional freedom—reduced anxiety, emotional dysregulation, and fear
Social ease—improved communication, connection, confidence
Physical resilience—better stress tolerance, coordination, sensory processing
Cognitive clarity—more presence, learning capacity, and adaptability
What happens in a functional neurology session?
What to Expect From Your Functional Neurology Appointment
What to expect & how it works
Hi and welcome!
I wanted to give you a quick overview of what functional neurology is, how it works, and what you can expect from your sessions with me.
The Nervous System ‘Bucket’ Theory
Think of your nervous system like a bucket. Over your lifetime, that bucket slowly fills up. Sometimes it’s big, obvious things like a concussion, surgery, or a traumatic event. Other times, it’s lots of little things that add up over time—stress, poor sleep, ongoing pain, childhood trauma, falls, inflammation, emotional suppression, or illness.
When that bucket overflows—when your nervous system reaches its threshold—that’s when symptoms often show up.
Pain. Anxiety. Depression. Exhaustion. Brain fog. Migraines. Gut issues. Behavioural challenges in children. A nervous system that’s just not coping.
And here’s the really interesting part: when the system is overwhelmed, the brain often reverts to its old default settings. That includes switching back on primitive reflexes that should’ve integrated in early development—or disintegrating ones that were once well-functioning.
What Are Primitive Reflexes—and Why Do They Matter?
Primitive reflexes are automatic movement patterns that are meant to help us survive in early life—but they’re supposed to switch off as the brain matures. When these reflexes stay active (or get reactivated later in life), they can cause a huge range of issues—physically, mentally, and emotionally.
For example:
Retained Moro reflex = easily startled, hyper-vigilant, difficulty calming down.
Retained ATNR or STNR = poor coordination, clumsy, neck/back pain, handwriting struggles.
Retained TLR = poor balance, fear of falling, motion sickness.
Palmar / plantar reflexes = chronic tension in hands, feet, or jaw.
So we start with checking all your primitive reflexes and cranial nerves to see how your brain and nervous system are functioning at a foundational level.
Then, using gentle corrections, we begin to reintegrate and reset your system so your brain stops running these old patterns.
What Happens in the First Appointment
In your first session, we:
Talk about your full history—because every detail matters
Assess your primitive reflexes
Check your cranial nerves
Begin corrections to help bring the nervous system back to a regulated state
This session is all about finding out what your system is doing and why, so we can get to the root cause rather than just treating symptoms.
What We Cover in Your Second Session
In the second session, we dive deeper into the visual and eye movement systems, including:
Eye tracking
Convergence and divergence (near/far focus)
Saccades (fast eye movements)
Optokinetics (how your brain processes movement in the world around you)
These systems tell us a lot about how well your brain is processing information—and how much effort it's using just to get through the day.
What We Can Explore in Ongoing Sessions
Once your brain and body have started to regulate and you’re feeling more balanced, we may explore deeper areas such as:
Emotional processing and stored trauma (especially in the heart wall)
Underlying infections or toxic load
Adrenal function, organ and gland imbalances
Your intrinsic core system, which plays a key role in chronic back and neck pain
Sleep, memory, and stress resilience
And how all of it connects through your brain-body feedback loop
What Clients Commonly Report
Many people come to me with issues like:
Pain that doesn’t respond to regular treatment
Ongoing tightness in the neck, shoulders or hips
Fatigue that feels like “running on empty”
Brain fog, poor memory or word-finding issues
Kids who are struggling with focus, behaviour, or reading
Anxiety that just doesn’t shift no matter what they try
If that sounds like you, know that you’re not alone—and that change is absolutely possible when we work with the nervous system itself.
A Final Note
Functional Neurology looks at the root cause, not just the symptoms. It’s gentle, non-invasive, and truly life-changing for many clients. Every person’s nervous system is unique, which is why we tailor every session to you.
Thank you again for trusting me with your care—I’m really looking forward to helping you or your child reset, reconnect and feel better from the inside out.
Guide to Neuro Reset Techniques
Practical Ways to Reset Your Nervous System and Calm Anxiety
When stress gets stuck, your nervous system needs a reset. Activating your vagus nerve — the longest nerve connecting brain and body — helps switch off fight/flight and bring calm. These techniques are easy, effective, and science-backed.
1. The Salamander Technique
The Salamander technique is not just a neck mobility exercise — it’s a powerful vagus nerve reset tool. By stimulating the brainstem where the vagus nerve originates, it helps shift your nervous system out of fight/flight mode and into a state of calm and relaxation.
One of my all-time favorite exercises for improving neck mobility, reducing pain and stiffness, and calming the nervous system is called the Salamander.
How to do it: - Interlace your fingers and place your hands gently at the back of your head, resting on the occipital area. - Slowly side-bend your upper body to one side while turning your eyes in the opposite direction. - Soften your gaze if needed. Hold until you feel a ‘vagal response’ (yawn, swallow, sigh). Return to center and switch sides.
What to expect: Yawning or swallowing are signs your nervous system is relaxing. Expect improved neck mobility and a sense of calm.
Why it works: This movement stimulates the brainstem, improving blood flow and regulating the vagus nerve and spinal accessory nerve.
2. Breathing Technique: Short Inhale, Extended Exhale
Breathing is one of the quickest ways to calm your nervous system by activating the vagus nerve. This simple method uses a short inhale followed by an exhale about twice as long.
How to do it: - Inhale gently through your nose. - Exhale slowly through your mouth, about twice as long as your inhale. - Repeat for a few breaths.
Why it works: The extended exhale releases acetylcholine, a calming neurotransmitter. It engages the diaphragm where the vagus nerve runs.
Important notes: If you feel air hunger or discomfort, pause and return to normal breathing. Use this when overwhelmed or anxious.
3. Morning Sunlight Exposure
Natural sunlight helps boost serotonin and regulate your body clock, reducing stress and improving sleep.
How to do it: - Get outside within the first hour of waking. - Spend 5–10 minutes in natural light without sunglasses (don’t look directly at the sun).
4. Bouncing on Heels & Shaking Hands
Inspired by Qigong practices like 'Shaking the Tree', these gentle movements help release tension and promote balance.
Bouncing on Heels: - Stand with feet hip-width apart. - Gently bounce on your heels for 1–2 minutes.
Benefits: - Releases stored tension - Calms the nervous system - Promotes circulation and energy flow
Shaking: - Gently shake your hands at your sides or through your arms/shoulders. - Relax your jaw and breathe normally.
Benefits: - Reduces cortisol - Enhances mental clarity - Improves blood flow
5. Gratitude Practice
Gratitude rewires the brain for positivity and reduces anxiety.
How to do it: - Write or say 3 things you’re grateful for each day. - Encourage kids to do it at breakfast or bedtime.
When to Use These Techniques
- When you feel overwhelmed, anxious, or tense. - When your kids are dysregulated or acting out. - As daily habits to build calm, resilience, and connection.
Bonus: Consistency is Key
Resetting your nervous system takes practice. Make these techniques regular habits and notice your family feeling calmer, more connected, and better able to handle life’s stresses.
Ready to take the next step?
If you or your child are feeling stuck in stress, anxiety, or overwhelm, these simple techniques are a great place to start — but sometimes we need deeper support. I offer gentle, evidence-based nervous system work that helps calm the body, improve emotional regulation, and support long-term healing.
👉 Book a Functional Neurology Session Today Let’s work together to reset your system and bring more calm, clarity, and connection into your everyday life.
The tools shared in this guide are inspired by the Functional Neurology training and mentorship I’ve received from Nick Moss. With thanks and respect for the knowledge passed on. @functionalneurohealth