Rehabilitative Sports After Traumatic Brain Injury: Integrative Care

Rehabilitative Sports After Traumatic Brain Injury: How Integrative Chiropractic Care and Nurse Practitioners Help

Understanding Traumatic Brain Injury and Rehabilitative Sports

A traumatic brain injury (TBI) can change how a person moves, thinks, feels, and connects with others. After the early hospital and therapy stages, many people still want to get stronger, feel more like themselves, and return to meaningful activities. Rehabilitative sports and adaptive recreation offer a powerful path to do exactly that.

Adaptive and rehabilitative sports are regular sports that have been safely modified for people with physical, sensory, or cognitive changes. This might mean using a different type of bike, playing basketball in a wheelchair, or working with a trained instructor in the pool. Studies and rehabilitation programs show that structured physical activity after TBI can improve strength, balance, mood, and even cognitive function when introduced at the right time and carefully monitored. BrainLine+2Flint Rehab+2

In an integrative care model, chiropractors and nurse practitioners (NPs) work together with physical therapists, occupational therapists, and adaptive sports coaches. Clinicians like Dr. Alexander Jimenez, DC, APRN, FNP-BC, in El Paso use this kind of team-based, dual-scope approach daily—combining spine and posture care, functional neurology, medical oversight, and exercise planning to make sports participation safer and more effective for people with brain injuries. El Paso, TX Doctor Of Chiropractic+2El Paso, TX Doctor Of Chiropractic+2

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Why Rehabilitative Sports Matter After TBI

Physical and Cognitive Benefits

Research and clinical guidelines show that properly dosed exercise after TBI can:

• Improve aerobic fitness and walking endurance

• Boost balance, coordination, and reaction time

• Support neuroplasticity (the brain’s ability to rewire itself)

• Enhance attention, memory, and executive function when paired with cognitive tasks BioMed Central+2Physiopedia+2

A short-term, tailored exercise program has been shown to improve work ability, balance, flexibility, and strength in people with TBI. FTR Dergisi At the same time, recreational and adaptive activities such as dance, aquatic therapy, art, and games can stimulate the brain while making exercise more fun and sustainable. Flint Rehab+1

Emotional and Social Benefits

After a brain injury, it is common to feel isolated, anxious, or depressed. Group sports and community outings help people:

• Rebuild confidence and identity

• Reduce feelings of isolation

• Practice communication and teamwork

• Experience joy and a sense of normal life again BrainLine+2Encompass Health+2

BrainLine highlights that adaptive sports programs allow people with TBI, PTSD, and other injuries to participate with more independence and connection, whether that is through wheelchair basketball, kayaking, or other structured programs. BrainLine+1

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Safety First: How to Return to Movement After TBI

Before starting any sport, the care team should confirm that the person is medically stable and ready for graded exercise. Professional guidelines stress the importance of:

• Medical clearance: ruling out dangerous problems like unstable neck injuries, uncontrolled seizures, or severe balance deficits

• Gradual progression: starting with low-intensity activity and increasing slowly as symptoms allow PubMed Central+1

• Monitoring symptoms: stopping or scaling back if headaches, dizziness, vision changes, confusion, or nausea increase

A nurse practitioner is often the central medical point of contact. They can review imaging, medications, and other conditions (like heart disease or diabetes) before clearing a patient for more challenging sports. Chiropractors, especially those with training in neurology and integrative rehabilitation, help make sure the spine, joints, and balance systems can tolerate new movement loads. HML Functional Care+2My Balance Matters+2

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Types of Rehabilitative and Adaptive Sports for People With TBI

1. Low-Impact Aerobic and Balance Activities

These activities are often the first step toward sport-level participation because they are easier to scale and adapt:

• Walking and supported hiking on accessible paths or nature trails

• Stationary or recumbent cycling, which offers stable support while training the heart and legs

• Tai chi or gentle martial arts, which emphasize slow, controlled movements and weight shifting

• Chair-based exercise (chair yoga, seated strengthening, or marching) for those with mobility or balance limits Illinois CMS+2Brain Injury Center+2

Many rehab programs and state wellness initiatives recommend seated hip movements, trunk flexion and extension, weight shifts, and heel-toe raises as building blocks for later participation in sports. Illinois CMS+1

Benefits:

• Build cardiovascular endurance

• Improve balance and postural control

• Offer an easy place to practice dual-tasking (for example, walking while naming words)

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2. Adaptive Court and Field Sports

Adaptive sports mirror typical sports but use rule changes, equipment modifications, or assistive devices. BrainLine and other adaptive programs describe many options for people with TBI and other injuries: BrainLine+2BrainLine+2

• Wheelchair or seated basketball

• Adapted cycling, including recumbent bikes and handcycles

• Slow-paced soccer or small-sided games

• Adaptive track and field, such as racing wheelchairs or guided running

Talented Ladies Club and other adaptive recreation resources explain that many of these sports can be played at beginner, recreational, or competitive levels, often through community or non-profit programs. Talented Ladies Club+1

Benefits:

• Improve coordination, agility, and reaction time

• Encourage teamwork and communication

• Offer structure, goals, and sometimes competition, which can be highly motivating

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3. Aquatic and Adaptive Water Sports

Water can be an ideal environment for TBI rehabilitation. Buoyancy reduces body weight, making it easier to move weak or spastic limbs, and water resistance helps build strength. Flint Rehab+1

Common aquatic options include:

• Adaptive swimming and water walking in a warm therapy pool

• Aquatic therapy with a therapist leading exercises

• Kayaking, canoeing, or paddleboarding using adaptive seats, outriggers, or tandem boats

Brain Injury Center and BrainLine both highlight adaptive water activities such as kayaking, paddleboarding, and boating as powerful experiences that build confidence and a sense of freedom. Brain Injury Center+2BrainLine+2

Benefits:

• Low joint impact but high muscular engagement

• Strong vestibular (balance) and core training

• Calming sensory input can reduce anxiety for some individuals

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4. Nature-Based and Community Activities

Not every rehabilitative sport has to look like a traditional “sport.” Community outings and simple outdoor activities play a major role in recovery:

• Accessible hiking and nature walks on flat or adaptive trails

• Fishing, camping, and gentle outdoor games adapted with supervision and safety planning

• Gardening, which combines physical activity, sensory input, and emotional regulation Encompass Health+2Flint Rehab+2

Encompass Health emphasizes community outings—such as shopping trips, museum visits, or group activities—as key opportunities to practice real-life problem-solving, navigation, and social interaction after TBI. Encompass Health Brain Injury Center adds ideas like inclusive cycling, accessible hiking, and outdoor art or crafting sessions that can be tailored to different ability levels. Brain Injury Center+1

Benefits:

• Support real-world independence

• Reduce sensory and social avoidance

• Allow graded exposure in a relatively controlled way

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5. Equine-Assisted Therapy and Therapeutic Riding

Equine-assisted therapies, such as hippotherapy and therapeutic horseback riding, use the movement and presence of horses to support physical and emotional recovery. A review of equine-based therapy for people with brain injury reports improvements in balance, postural control, muscle tone, and emotional well-being. Refubium+1

For TBI survivors, equine programs can:

• Challenge trunk and neck control through the rhythmic motion of riding

• Improve balance responses and core strength

• Build trust, confidence, and emotional regulation through connecting with the horse

These programs must be closely supervised and are typically initiated only after basic balance and medical stability are established.

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6. Home and Creative Activities That Prepare for Sports

Not everyone is ready for team sports right away. Home-based and creative activities can be stepping stones. Krysalis Consultancy offers a list of more than 200 home activities that support brain injury survivors and their families—from simple stretching and walking to structured games and crafts. Krysalis Consultancy+1

Flint Rehab describes many enjoyable activities that can double as therapy, such as: Flint Rehab+1

• Puzzles and board games

• Dancing or music-based movement

• Art projects like painting

• Gardening, cooking, or community outings

• Video game–based or gamified therapy tools

Assured Assisted Living notes that tailored physical activities—such as targeted walking drills, strength training, and functional tasks—are central to brain-injury rehabilitation and can be adapted to home or assisted-living environments. Assured Assisted Living

Benefits:

• Build physical, cognitive, and emotional readiness for more complex sports

• Allow frequent practice with minimal equipment

• Fit into daily routines and family life

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How Integrative Chiropractic Care Supports Rehabilitative Sports

Integrative chiropractic care looks beyond quick symptom relief and focuses on long-term function, posture, and nervous system health. Several chiropractic and functional neurology sources show how this approach fits into TBI recovery and sports participation. Atlas Chiropractic & Wellness Center+3HML Functional Care+3Integrative Chiropractic & Wellness+3

1. Spinal Alignment, Posture, and Balance

After a TBI, especially one related to crashes or sports, the neck and upper back are often affected. Dr. Jimenez and other integrative chiropractors note that cervical and upper thoracic misalignments can worsen headaches, dizziness, and balance problems. Correcting these issues can support safer movement and sports participation. El Paso, TX Doctor Of Chiropractic+2El Paso, TX Doctor Of Chiropractic+2

Chiropractic support may include:

• Gentle spinal and extremity adjustments

• Soft-tissue work to reduce tightness and trigger points

• Posture retraining, including head and neck alignment

• Specific home exercises to reinforce new movement patterns Integrative Chiropractic & Wellness+1

2. Functional Neurology and Vestibular Support

Chiropractic neurology focuses on how the brain and nervous system control movement, balance, and coordination. Clinics that use this approach—like functional care centers and integrative chiropractic practices—often combine: HML Functional Care+2El Paso, TX Doctor Of Chiropractic+2

• Eye and head movement drills

• Balance tasks using foam pads, balance boards, or gait exercises

• Sensory and movement therapies that challenge the brain in a controlled way

These therapies overlap with sport skills. For example, a patient might practice:

• Tracking a ball with their eyes while standing on an unstable surface

• Turning the head while walking and staying on a line

• Doing gentle dual-task drills, like tossing a ball while counting

Over time, these skills support safer participation in activities like basketball, cycling, or hiking.

3. Pain Management and Movement Restoration

Pain from neck, back, or joint injuries often limits participation in sports more than the brain injury itself. Chiropractic care can help reduce pain by:

• Improving joint motion

• Decreasing muscle spasm

• Supporting healthy posture and movement patterns

Integrative chiropractic clinics emphasize that rehabilitation transforms adjustments into a comprehensive program. When patients add targeted strengthening, flexibility work, and movement training to chiropractic care, they often improve faster and lower their risk of re-injury. Integrative Chiropractic & Wellness+2Injury 2 Wellness Centers+2

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The Role of Nurse Practitioners in TBI Sports Rehabilitation

Nurse practitioners are essential in designing and monitoring a safe sports plan after TBI. Their training allows them to combine medical assessment with practical, everyday guidance.

Key responsibilities include:

1. Medical Clearance and Risk Assessment

• Reviewing imaging, lab tests, and specialist reports

• Checking for uncontrolled seizures, severe heart or lung disease, unmanaged blood pressure, or other conditions that might limit certain sports

• Assessing vision, balance, and cognition to guide appropriate activity levels UAMS Health+1

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2. Medication Management

• Adjusting medications that affect alertness, balance, or heart rate

• Watching for drug interactions that could worsen dizziness, fatigue, or blood pressure changes during exercise

• Coordinating pain control strategies so that patients can move without masking serious warning signs

3. Care Coordination and Safety Monitoring

Nurse practitioners often act as the “hub” of the care team. They can:

• Refer to physical therapy, occupational therapy, speech therapy, and neuropsychology

• Connect patients with adaptive sports programs, community recreation centers, or veteran-focused adaptive sports groups BrainLine+2BrainLine+2

• Monitor progress and adjust activity levels based on symptom changes

4. Education, Lifestyle, and Long-Term Support

NPs educate patients and families about:

• Pacing and energy conservation

• Sleep, nutrition, hydration, and stress management

• Recognizing red-flag symptoms that mean it is time to slow down or seek urgent care

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In integrative settings like Dr. Jimenez’s clinics, the NP role blends medical care with functional and lifestyle medicine—helping patients line up diet, supplements, and daily routines with their sports and rehab goals. El Paso, TX Doctor Of Chiropractic+2LinkedIn+2

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Working as a Team: How Integrative Care Brings It All Together

In a truly integrative model, the patient is at the center, and each professional plays a specific role:

• Integrative chiropractor

  • Evaluates spine, posture, and movement

  • Provides adjustments and neuromuscular retraining

  • Designs exercise progressions that match brain and body readiness

• Nurse practitioner

  • Ensures medical stability and manages medications

  • Screens for complications like mood disorders, sleep problems, or autonomic symptoms

  • Coordinates referrals, imaging, and follow-up

• Therapists and adaptive sports specialists

  • Physical and occupational therapists design targeted strengthening and functional tasks

  • Recreational therapists or adaptive sports coaches customize sports and equipment

  • Neuropsychologists support cognitive and emotional recovery

Dr. Jimenez’s clinical work and writings on TBI and posture highlight how combining these roles leads to better function, improved balance, and safer progression into more challenging activities and sports. El Paso, TX Doctor Of Chiropractic+2El Paso, TX Doctor Of Chiropractic+2

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Building a Personalized Rehabilitative Sports Plan

Every TBI is different, so no single sports plan works for everyone. However, a simple framework can guide planning with an integrative chiropractor and nurse practitioner.

Step 1: Clarify Your Starting Point

• What are your current symptoms (headache, dizziness, fatigue, visual problems)?

• How is your balance when you stand, walk, or turn?

• What medical conditions or medications may affect your tolerance for exercise?

Formal assessments by your care team—such as balance tests, gait observation, cervical spine exams, and basic cognitive screens—help answer these questions. El Paso, TX Doctor Of Chiropractic+2PubMed Central+2

Step 2: Choose One or Two Low-Risk Activities

Examples:

• Short, supported walks or stationary cycling

• Gentle tai chi or chair-based stretching

• Basic water walking or supported pool exercises

The goal is to build consistency first, not intensity. Your chiropractor and NP can suggest safe starting durations, like 5–10 minutes, and help you track symptoms before, during, and after activity. Illinois CMS+1

Step 3: Add Cognitive and Balance Challenges Gradually

Once basic activity feels comfortable, your team may add dual-task and balance challenges, such as:

• Naming categories while walking

• Practicing head turns while standing on a firm or soft surface

• Doing simple ball tosses while in a seated or standing position

These kinds of “exercise plus thinking” drills support both brain and body recovery and prepare you for more complex sports. PubMed+2PubMed Central+2

Step 4: Transition Into Adaptive Sports

With medical clearance and good symptom control, you can explore adaptive sports that match your interests, such as:

• Wheelchair or seated basketball

• Recumbent or hand cycling

• Adaptive swimming or kayaking

• Hiking on accessible trails

• Therapeutic horseback riding, when appropriate Flint Rehab+3BrainLine+3Brain Injury Center+3

Your care team should communicate with adaptive sports coaches so everyone understands your limits, precautions, and goals.

Step 5: Maintain and Progress

Long-term, the focus shifts to:

• Maintaining regular activity (several days per week)

• Adjusting intensity and duration over time

• Rotating activities to prevent boredom and overuse injuries

• Checking in with your chiropractor and NP if new pain, dizziness, or cognitive symptoms appear

Exercise guidelines for TBI suggest that ongoing aerobic and strengthening programs can continue to improve cognition, mood, and physical function, even months or years after the original injury. Physiopedia+2Semantic Scholar+2

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Example: A Gentle Weekly Rehabilitative Sports Routine

This is a sample outline only. Actual plans must be individualized and cleared by a medical professional.

Early-Stage or Lower-Intensity Week

• Day 1 – 10–15 minutes of gentle walking or recumbent cycling + 5 minutes of stretching

• Day 2 – 20–30 minutes of chair yoga and light resistance band exercises

• Day 3 – Aquatic therapy or water walking in a warm pool (as guided by a therapist)

• Day 4 – Rest or light home activity (gardening, puzzles, simple games)

• Day 5 – Tai chi session focusing on posture and slow weight shifts

• Day 6 – Short, supervised hike on a flat trail or park path

• Day 7 – Rest, relaxation, and gentle range-of-motion exercises

Later-Stage or Higher-Functioning Week

• 1–2 days of adaptive or low-impact team sports (e.g., wheelchair basketball, tennis, or cycling group)

• 1–2 days of strength and balance training guided by a chiropractor or therapist

• 1 day of aquatic sports such as swimming or kayaking

• 1 day of equine therapy or community outing (museum, market, or event)

• 1–2 lighter days focused on stretching, yoga, or creative activities

Throughout, an integrative chiropractor and nurse practitioner monitor posture, balance, symptom changes, and overall health, adjusting the plan as needed.

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Key Takeaways

• People with traumatic brain injuries can safely participate in a wide range of rehabilitative sports—including adaptive basketball, cycling, swimming, canoeing, tai chi, hiking, equine therapy, and outdoor recreation—when activities are matched to their abilities and medical status. Refubium+3BrainLine+3Brain Injury Center+3

• Exercise and adaptive sports support physical strength, balance, cognition, mood, and social connection, all of which are critical for long-term recovery. BioMed Central+3Flint Rehab+3Physiopedia+3

• Integrative chiropractic care helps restore spinal alignment, posture, pain control, and neuromuscular coordination, creating a safer foundation for sports and activity. Injury 2 Wellness Centers+3HML Functional Care+3Integrative Chiropractic & Wellness+3

• Nurse practitioners provide medical oversight, manage medications, screen for red flags, and coordinate care across therapists and adaptive sports programs. UAMS Health+2El Paso, TX Doctor Of Chiropractic+2

• Together, these professionals can design personalized sports plans that respect each person’s specific TBI, health status, and goals—whether that goal is walking a nature trail, playing adaptive basketball, or returning to favorite recreational activities.

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References

Brain Injury Center. (n.d.-a). Accessible summer adventures: Fun activities for individuals with disabilities. Brain Injury Center. https://braininjurycenter.org/blog/?article=214 Brain Injury Center

Brain Injury Center. (n.d.-b). Fun fitness routines for recovery: Light-hearted exercise ideas for brain injury survivors. Brain Injury Center. https://www.braininjurycenter.org/blog/?article=223 Brain Injury Center

BrainLine. (2022, May 10). The healing power of adaptive sports for people with TBI, PTSD, spinal cord injury, and other challenges. BrainLine. https://www.brainline.org/article/healing-power-adaptive-sports-people-tbi-ptsd-spinal-cord-injury-and-other-challenges BrainLine

BrainLine. (n.d.). Adaptive sports. BrainLine Treatment Hub. https://www.brainline.org/treatment-hub-treating-brain-injury-and-ptsd/adaptive-sports BrainLine

CMS Illinois. (n.d.). Traumatic brain injury recovery. Illinois Department of Central Management Services. https://cms.illinois.gov/benefits/stateemployee/bewell/getmoving/traumatic-brain-injury-recovery.html Illinois CMS

Flint Rehab. (2022, March 23). Activities for brain injury patients: 15 fun, therapeutic options. Flint Rehab. https://www.flintrehab.com/activities-for-brain-injury-patients/ Flint Rehab

Groth, S. (2020). Horses as healers: Positive effects of equine based therapy on patients with a brain injury: A review [Bachelor’s thesis]. Freie Universität Berlin. https://refubium.fu-berlin.de/handle/fub188/31010 Refubium

HML Functional Care. (2025, July 22). How chiropractic neurology supports brain healing. HML Functional Care. https://hmlfunctionalcare.com/how-chiropractic-neurology-supports-brain-healing/ HML Functional Care

Krysalis Consultancy. (n.d.). Providing neurological occupational therapy within the COVID-19 stay at home rules: Over 200 activities for brain injury survivors and their families. Krysalis Consultancy. https://www.krysalisconsultancy.co.uk/resources/item/over-200-home-activities-for-brain-injury-survivors Krysalis Consultancy

Talented Ladies Club. (2024, November 5). Adaptive sports and recreation for people with paralysis: How to stay active. Talented Ladies Club. https://www.talentedladiesclub.com/articles/adaptive-sports-and-recreation-for-people-with-paralysis-how-to-stay-active/ Talented Ladies Club

Assured Assisted Living. (2024, May 16). Physical rehabilitation activities that aid brain injury recovery. Assured Assisted Living. https://www.assuredassistedliving.com/physical-rehabilitation-activities-aid-brain-injury-recovery Assured Assisted Living

Essential ChiroCare. (2024, July 12). Regaining your function, reducing pain, and more – The benefits of physical therapy for a TBI. Essential ChiroCare. https://www.essentialchirocare.com/regaining-your-function-reducing-pain-and-more-the-benefits-of-physical-therapy-for-a-tbi essentialchirocare.com

Encompass Health. (2023, December 4). Community outings for individuals with brain injuries. Encompass Health. https://www.encompasshealth.com/health-resources/articles/community-outings-for-individuals-with-brain-injuries Encompass Health

Injury 2 Wellness. (2025, January 30). Optimizing recovery: Chiropractic exercises for injury rehabilitation. Injury2Wellness. https://injury2wellness.com/optimizing-recovery-chiropractic-exercises-for-injury-rehabilitation/ Injury 2 Wellness Centers

Integrative Chiropractic. (2024, December 3). The power of rehabilitation in chiropractic care: Enhancing recovery and preventing re-injury. Integrative Chiropractic. https://integrativechiropractic.net/blog/the-power-of-rehabilitation-in-chiropractic-care-enhancing-recovery-and-preventing-re-injury/ Integrative Chiropractic & Wellness

Atlas Chiropractic & Wellness Center. (2025, April 24). Natural recovery from concussion and TBI. Atlas Chiropractic & Wellness Center. https://atlaswellness.com/natural-recovery-from-concussion-and-tbi/ Atlas Chiropractic & Wellness Center+1

My Balance Matters. (n.d.). Chiropractic care for concussions: A holistic approach to recovery and rehabilitation. My Balance Matters. https://www.mybalancematters.com.au/articles/chiropractic-care-for-concussions-a-holistic-approach-to-recovery-and-rehabilitation My Balance Matters+1

PhysioPedia. (n.d.). Physical activity guidelines for traumatic brain injury. PhysioPedia. https://www.physio-pedia.com/Physical_Activity_Guidelines_for_Traumatic_Brain_Injury Physiopedia

Romanov, R., et al. (2021). The effects of adapted physical exercise during traumatic brain injury rehabilitation. Turkish Journal of Physical Medicine and Rehabilitation. https://www.ftrdergisi.com/pdf.php?id=4320 FTR Dergisi

Shen, Y., et al. (2025). A comprehensive review of rehabilitation approaches for mild-to-moderate traumatic brain injury. Frontiers in Neurology, 16, 1608645. https://www.frontiersin.org/articles/10.3389/fneur.2025.1608645/full PubMed Central

López, L. P., et al. (2024). Aerobic exercise and cognitive function in chronic severe traumatic brain injury. BMC Sports Science, Medicine and Rehabilitation, 16, 24. https://bmcsportsscimedrehabil.biomedcentral.com/articles/10.1186/s13102-024-00993-4 BioMed Central

Dr. Alex Jimenez. (2025, October 31). Traumatic brain injury and posture: Signs and solutions. DrAlexJimenez.com. https://dralexjimenez.com/traumatic-brain-injury-and-posture-signs-and-solutions/ El Paso, TX Doctor Of Chiropractic+1

Dr. Alex Jimenez. (n.d.). Posture exercises after TBI: Integrative chiropractic care. DrAlexJimenez.com. https://dralexjimenez.com/posture-exercises-after-tbi-integrative-chiropractic-care/ El Paso, TX Doctor Of Chiropractic+1

Dr. Alex Jimenez. (n.d.). El Paso, TX Doctor of Chiropractic – Functional medicine & integrative wellness treatment center. DrAlexJimenez.com. https://dralexjimenez.com/ El Paso, TX Doctor Of Chiropractic

LinkedIn. (n.d.). Dr. Alexander Jimenez DC, APRN, FNP-BC, IFMCP, CFMP. LinkedIn. https://www.linkedin.com/in/dralexjimenez/ LinkedIn+1