El Paso's Scientific Chiropractor
I hope you have enjoyed our blog posts on various health, nutritional and injury related topics. Please don't hesitate in calling us or myself if you have questions when the need to seek care arises. Call the office or myself. Office 915-850-0900 or My Cell 915-540-8444 Great Regards. Dr. J

The Meniscus: A Scientific Perspective

El Paso, Tx.’s Scientific chiropractor Dr. Alexander Jimenez looks at a case study of a rugby player who got more than he wanted to tackle.

The Player & Mechanism Of Injury

A 115kg rugby union player who plays as a hooker is presented by this case study. During a competitive game he went in to execute a tackle with a bent knee, and the player being tackled fell onto him. As he went to get up off the floor that he felt popping sensation and a severe pain in the knee and he was unable to straighten the knee. He was not able get to a position to come off the field or to straighten it and immediately fell to the floor with the knee locked in 30 degrees of flexion. He was stretchered off the field and taken immediately to the medical room where he had been administered some powerful painkilling medications (Entonox). At the time his knee was far too painful to test properly; however, the attempted examination by the physician discovered that the knee was not able to be unlocked, a gross swelling had already begun but the joint play on anterior draw (Lachman’s test) felt normal.

It was felt that due to the discomfort, the rapid and the inability to unlock the knee, the diagnosis was that the player had sustained an meniscus rupture or had endured a tibial plateau fracture.

The player underwent an MRI of the injured knee the next day. The report was as follows:

Findings

There has been an acute tear of the meniscus with flipping of the posterior horn fragment to the anterior part of the lateral tibiofemoral compartment.

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  • No injuries are seen inside the joint compartment.
  • The ACL is undamaged.
  • The PCL, medial and lateral collateral ligaments are intact.
  • The corner structures are intact.
  • No meniscal tear is seen.
  • No injuries are observed in the medial tibio
  • There is fibrillation to the medial patellar facet cartilage at the level of the patella equator.
  • No injuries are seen within the trochlea.
  • No signs of subluxation is observed.
  • Patellar tendon and the quadriceps expansion appear within normal limits.

Impression

  • Acute tear of the lateral meniscus with flipping of the posterior meniscal fragment into the anterior lateral tibiofemoral joint compartment.

The player was treated surgically with a repair and the flap was success- fully relocated and sutured into position. He was discharged wearing a motion-limiting brace (0-60 degrees originally). The rehab program is explained below. He returned to play with operative and had no difficulties.

Anatomy Of The Meniscus

The plateaus are attached to by the two meniscus and the congruency of the tibia enhances . The meniscus are made from a fibrocartilage and they are wedge-shaped. The two meniscus are ‘C’-shaped being the lateral more curved and more crescent-shaped. The meniscus attach to the tibial plateau in the anterior and posterior horns through the intercondylar eminence. They are attached at the periphery with ligaments.

Uniquely the medial collateral ligament which restricts the freedom of the meniscus is attached to by the medial meniscus. The lateral meniscus is attached to the femur via two specific ligaments (ligaments of Wrisberg and Humphreys).

The unique blood supply to the meniscus determines its healing capability in the event of injury. The peripheral portion of the meniscus (between 10-30%) receives a direct blood supply and this is known as the red-red zone of the meniscus. Terminal loops are sent by the small blood vessels to the center material of the meniscus and this is termed the red-white zone of the meniscus. The part that is remaining only receives nourishment and this is called the zone that is white-white.

The meniscus have a range of significant functions that are biomechanical. They function as a shock absorber (they can absorb as much as 45-70% of weight-bearing load) as well as a spacer between the femur and tibia to prevent any connection between the two bones, they offer a degree of knee stability, and also have a proprioceptive function. The joint surfaces are also lubricated by their existence in the knee. This is evident in knees which have had meniscus removal — they show onset arthritic changes as the bones no longer have a cushioning effect.

Throughout knee flexion the femoral condyles slide and load the posterior horn of the meniscus. The knee also internally rotates with knee flexion and a shear effect is imparted by this across the meniscus the medial meniscus nonetheless, the meniscus translates by double the space of the medial meniscus in a front-to-back direction during knee flexion. These two features that are biomechanical make the meniscus more susceptible to injury in flexion and rotation.

Forces Acting On The Knee

Meniscal tears in the knee occur when the knee is flexed and concurrently and the condyle loads the meniscus the knee rotates along with a shear force is applied to the meniscus. If the meniscus collagen’s ability to withstand this shear is exceeded by this shear force, a tear will result. This happens in the athletic knee. This sometimes happens typically in cutting and step- ping actions or landing and twisting simultaneously. The athletic activities most likely to make this shear effect on the knee are NFL, soccer, rugby, volleyball, netball and tennis.

In an older degenerated knee, the fluid content of the meniscus is reduced due to age-related changes to the meniscus and cartilage structures. It’s much easier to damage the meniscus with in a knee with a meniscus that is degenerated.

Clinical Features Of Meniscal Tears

Subjective

The individual usually remembers the specific mechanism of injury as being a step or cutting maneuver that induces knee flexion and then adds spinning (netball, basketball, volleyball, soccer, touch rugby), or they might be tackled and the knee is forced into rotation (rugby, NFL). Furthermore, the patient may be caught in a deep squat posture and tries to bounce out of that position (‘bum to ground’ squats) or they may fall and slide with their knee flexed (MMA, martial arts, extreme sports). As the latter occurs, the foot may be caught on the floor as the knee is flexed and a rotational force may be applied to the knee.

The level of pain experienced can vary depending on the kind of tear and if concomitant injuries like collateral ligaments and ligaments are involved. Some tiny tears might be painless and pose as a sore knee afterwards. This might be more prevalent with older degenerated knees. Some individuals may experience a definitive popping sensation as the tears acutely or tearing sensation.

More severe injuries such as bucket handle the meniscus may be displaced by tears . These may spontaneously unlock using a sensation.

Objective

An torn meniscus’ typical features are:

  • joint effusion. This will be detected during examination on a standard fluctuation test;
  • joint line tenderness. This is more prevalent with meniscus tears;
  • Pain on loaded flexion — duck and squats walks;
  • restricted flexion and/or extension (in anterior horn tears). This may be pain- limited and/or restricted by a block (because of the torn meniscal flap). ;
  • McMurray’s test (passive flexion/rotation) may be positive in an acute tear; however, the rate of false negatives can be very high. A McMurray’s may replicate a clunk or click in the knee.

Management

Whether surgery is not needed by a meniscus or not depends upon a number of key variables:

  • The zone — red zone tears cure well whereas zone tears don’t heal;
  • Type of tear bucket handle tears will probably cause locking of the knee so need surgery. Tears that are slightly painful but not locked may do well with conservative management;
  • Demand of the sportsman — a young footballer will require as meniscus as possible, therefore surgical repair would be indicated.

Brukner and Khan (2012) have offered a number of criteria which might help in determining surgical versus nonsurgical treatment.

Furthermore, Noyes et al (2012) provide additional advice on whether the tear should be repaired or removed.

In the case study presented, the player had an inability to compete and an episode of twisting, had a locked knee with his McMurray’s and severe pain was unable to be analyzed as a result of pain. So surgery was the only option, the MRI confirmed the severity of the tear and displacement.

Surgery

The purpose of surgery is to preserve as much of the meniscus as possible. In athletes, the current preference is by repairing the tear with sutures preserve the meniscus. In knees and crush that is severe type accidents will the meniscus be eliminated. Unfortunately not all meniscus tears can be repaired, especially if damage has occurred.

Long-term follow-up of meniscus injuries that are debrided versus mended reveal that in debrided meniscus, the chance of early onset osteoarthritis is much higher due to the reduction in surface of the meniscus.

Variations exist in the sort of repairs that a surgeon may perform. It is generally accepted that sutures are prefer- able as perpendicular runs to the circumferential fibers of the meniscus to horizontal sutures.

The timeframe for rehabilitation will differ based on the location and extent of the tear. Tears of the meniscus which are repaired will require more than lateral tears.

Monitoring of the knee is required as remaining meniscus and the articular cartilage take the time to adapt to load increases. Monitoring of signs such as knee and effusion stiffness will alert the clinician that the knee is not able to accommodate to loads that are applied.

Although not discussed in this bit, more and more evidence is showing that meniscus transplantation can be successful in the management of meniscus.

Post-Surgical Rehabilitation

The player’s post-surgical rehabilitation is presented as a color-coded chart below. The purpose of the chart is that it represents a visual reference point for the player to refer to. It progresses through different stages or different ‘danger zones’. Black represents the high-risk stage then it passes through red, orange, yellow, green and finally white when there is minimal risk.

The key features of the attached rehabilitation program are as follows:

Weight bearing status

1. The surgeon initially wanted the player non-weight bearing as the lateral meniscus had sustained a significant delamination off the tibial plateau.

2. Partial weight-bearing on crutches started at four weeks post-op and progressed over the two weeks until he was full weight-bearing at week six post- op. The player continued to use crutches in full weight-bearing when outdoors for safety up to seven weeks post-op.

Range of movement

1. Due to the extensive nature of involvement of the lateral meniscus, the surgeon wanted the player motion-limited for the first four weeks from 0-60 degrees. He was concerned that flexion past 60 degrees would create excessive compressive effect on the posterior horn of the meniscus.

2. From week four the brace was opened up to 75 degrees and then in week 5 to 90 degrees.
3. The brace was removed at seven weeks post-op.

Physiotherapy/manual therapy

1. Range of allowable movement (0-60) was maintained with:

  • patellofemoral mobilizations
  • passive and active knee flexion/extension
  • soft tissue massage to calves, popliteus, hamstrings and ITB.

Exercise therapy

1. The player was initially started on simple inner range quads in supine (0-20 degrees), straight leg raise and active knee flexion/extension in motion limiting brace in sitting on bed.

2. A muscle stimulator (Compex) was used to maintain quads (disuse atrophy mode).

3. Hip exercises were also started focusing on hip abduction (side lie) and extension (prone).

4. From week 4 post-op he started using a muscle stimulator in single leg squat position in brace.

5. From week 6 he was performing muscle hypetrophy mode muscle stim squats on single leg from 0-60 degrees.

6. He started leg press (0-60) at week 7.

7. He started two-legged squats (0-60) at week 9 and the range was increased 10-20 degrees per week over weeks 10-15. He was performing full squats (0-110 degrees – parallel thigh) by 15 weeks post-op.

8. He squatted 180kg for six reps at 15 weeks post-surgery (his PB was 210kg for six reps).

Posterior chain

1. The player started loaded hyperextension and reverse hyperextension exercises from week 4.

2. He started bridging in brace from week 5.

3. He started performing hip thruster in brace from week 6.

4. More high demand hip-dominant exercises were then added weekly.

Cardio/cross train

1. Seated boxing was started at week 2 post-op.

2. Swimming with no kicking was started at week 4 post-op (enough time to allow full suture healing).

3. High seat bike was started at week 6 to limit knee flexion to 0-60.

4. Cross trainer was started at week 8.

5. Deep water running was introduced at week 10 (this required more than 60 degrees of knee flexion hence why it was delayed until week 10).

6. Alta G (anti-gravity treadmill running) at 50% bodyweight was introduced at week 10 and this went to 80% week 11.

7. Hard anaerobic efforts on Watt bike were introduced from week 12.

Running

1. Alta G running started at week 10 although this was low-level intensity – 8-10 kph.

2. The surgeon reviewed the player at 12 weeks post-op and allowed the player to commence ground running.

3. The player ran every second day and the volume was gradually increased each session.

4. Over three weeks the player ran on 13 occasions. The distance was gradually increased from 500m to 6km over the 13 sessions. A player of his position would cover 6-8 km a game so the bottom end of the distance expectation was chosen.

5. Speed elements were gradually introduced over the 13 sessions; however, top speed was delayed until the second last session.

6. The player ran a standard 1.2km field shuttle fitness test at week 13 post-op. His pre-injury best was 5.04mins and his first attempt post-injury was 5.15, which was well within 90% of his best effort.

7. He started change of direction at 15 weeks post-op and quickly progressed through the stages.

8. He also started non-contact skills work at 15 weeks post-op.

Skills/rugby

1. As a line out forward he is required to throw the ball into the line out; this skill element was maintained early on by incorporating seated (on Swiss ball) throwing from week 4.

2. He started standing throwing at week 10 post-op.

3. Solitary machine scrums started at week 14, five-man scrums at week 15 and full scrums in weeks 16 and 17.

4. Non-contact skills started at 15 weeks post-op.

5. Progressive contact training was started at week 13 and quickly progressed over four weeks.

Criteria For Returning To Play

The accepted criteria for return to play following surgery are:

1. No effusion;

2. Full range of movement;

3. Normal quadriceps bulk and strength;

4. Equal proprioception left to right (as measured with a star excursion balance test – SEBT);

5. Full completion of training for two weeks;

6. Strength levels within 90% of pre- injury levels; and

7. Field conditioning tests within 90% of pre-injury levels.

Conclusion

This case study presents a instance of a flipped bucket handle tear of a meniscus in an elite level rugby player. A mechanism of injury resulted in an irreducible locked knee and the posterior horn of the meniscus flipping itself in the anterior compartment of the knee and detaching from the attachment, leading to acute pain.

Successful surgery allowed for preservation and a full recovery of the lateral meniscus with no loss of meniscal substance. The mature of the injury resulted in a protracted rehabilitation period nonetheless, the player involved was able to successfully return to play after surgery.

References
1. Brukner et al (2012) Clinical Sports Medicine (4th edition). McGraw-Hill Australia. NSW.
2. Noyes et al (2012) Meniscus repair and transplantation: a comprehensive update. Journal of Orthopedic and Sports Physical Therapy. 42(3): 274-290.
3. Brindle et al (2001) The meniscus: review of basic principles with application to surgery and rehabilitation. Journal of Athletic Training. 36(2); 160-169.
4. Rath E and Richmond JC (2000) The menisci: basic science and advances in treatment. Br J of Sports Medicine. 34: 252-257.
5. McDermott I (2011) Meniscal tears, repairs and replacement: their relevance to osteoarthritis of the knee. Br J of Sports Medicine. 45: 292-297.

Dr. Alexander Jimenez ♛
Chiropractor💡 Author • Researcher • Injury & Sciatica Clinician • Wellness Specialist • 915-850-0900 📞
We Welcome You 👊🏻.
Purpose & Passions: I am a Doctor of Chiropractic specializing in progressive cutting-edge therapies and functional rehabilitation procedures focused on clinical physiology, total health, functional strength training and complete conditioning. We focus on restoring normal body functions after neck, back, spinal and soft tissue injuries.

We use Specialized Chiropractic Protocols, Wellness Programs, Functional & Integrative Nutrition, Agility & Mobility Fitness Training and Cross-Fit Rehabilitation Systems for all ages.

As an extension to dynamic rehabilitation, we too offer our patients, disabled veterans, athletes, young and elder a diverse portfolio of strength equipment, high performance exercises and advanced agility treatment options. We have teamed up with the cities premier doctors, therapist and trainers in order to provide high level competitive athletes the options to push themselves to their highest abilities within our facilities.

We’ve been blessed to use our methods with thousand of El Pasoans over the last 3 decades allowing us to restore our patients health and fitness while implementing researched non-surgical methods and functional wellness programs.

Our programs are natural and use the body’s ability to achieve specific measured goals, rather than introducing harmful chemicals, controversial hormone replacement, un-wanted surgeries, or addictive drugs. We want you to live a functional life that is fulfilled with more energy, positive attitude, better sleep, and less pain. Our goal is to ultimately empower our patients to maintain the healthiest way of living.

With a bit of work, we can achieve optimal health together, no matter the age or disability.

Join us in improving your health for you and your family.

Its all about: LIVING, LOVING & MATTERING! 🍎

Welcome & God Bless

2 CONVENIENT LOCATIONS:

CENTRAL ELPASO:
6440 Gateway East, Ste B

EAST SIDE ELPASO:
11860 Vista Del Sol, Ste 128

PHONE: 915-850-0900 ✔️

Staff

Meet the Staff
Staff Ethics
These canons of professional ethics are based upon fundamental principles of moral and professional behavior and recommended for all doctors of chiropractic and chiropractic assistants. The following basic principles should be guiding factors in the practice of chiropractic and upheld at all times:
Consider the well-being of the patient. The primary effort and ultimate goal is for the greatest good of our patients.
  • Dr. Alexander D. Jimenez D.C., C.C.S.T
    Chief Clinical Director
    Phone:   9155408444
    Email:     doctorback@gmail.com

    Specializing in Severe Pain: Sciatica, Neck-Back Pain, Whiplash, Headaches, Knee Injuries, Sport Injuries, Dizziness, Poor Sleep, Arthritis. We use advanced proven therapies focused on optimal mobility, health, fitness, and structural conditioning. We use Patient Focused Diet Plans, Specialized Chiropractic Techniques, Mobility-Agility Training, Cross-Fit Protocols and the "PUSH System" to treat patients suffering from various injuries and health problems.

    Message from: Dr. Alex Jimenez D.C., C.C.S.T

    ( Biography and my promise to you )

    Hello-Bienvenido's,
    My name is Dr. Alex Jimenez, I am Chiropractic Doctor specializing in advanced therapies focused on total joint health, strength training and complete fitness conditioning. We use patient Focused Diet Plans, Advanced Chiropractic Techniques, Agility Training, Cross-Fit and the PUSH System to treat patients suffering from various injuries and health problems. Our goal too is to help your body heal itself naturally. When your body is truly healthy, you will arrive at your fitness level and proper weight efforlessly. We want to help educate you on how to live a new and improved lifestyle. Our doctors have spent over 25+ years researching and testing methods with thousands of patients. We strive to create fitness and better the body through researched methods and total programs...

    My goal too is to help the body heal itself naturally. When your body is truly healthy and balanced, you will move pain free and ultimatly arrive at your optimal fitness levels and proper weight effortlessly. We want to help educate you on how to live a new and improved lifestyle. Our doctors have spent over 25 years researching and testing methods with thousands of patients. We strive to create fitness and better the body through researched methods and total programs. These programs are natural, and use the body's own ability to achieve goals of improvement, rather than introducing harmful chemicals, controversial hormone replacement, surgery, or addictive drugs. We want you to live a life that is fulfilled with more energy, positive attitude, better sleep, less pain, proper body weight and educated on how to maintain this way of life.

    The focus on spinal and skeletal adjustments is what makes doctors of chiropractic unique in their approach to treating patients with spinal complaints. This hallmark chiropractic adjustment, however, is not the only procedure a chiropractor may employ in managing a patient's care. I am very proud to bring my patients a variety of treatment options beyond the typical scope of care. With the advances in physical therapies and modalities we bring El Paso option that better aid in the rehabilitation process. Tissue healing is a wonderful process that begins the moment an injury occurs. How the injury is managed determine the final outcome in terms of healing. It is critical we implement immediate procedures as soon as we can in order to gain optimal recovery. The old day of let it rest until it gets better is not the only option.

    Letting it rest may even be an irresponsible approach considering what we now know. The implementation of active and movement based treatments have clearly shown increased and improved outcomes in many instances.

    As a doctors focused on the greater good for a patient, we must assess each patient individually and apply the appropriate protocols. It is also very important to denote, that El Paso has fine doctors in many specialties of healing and repair. The direct relationship we have with specialist of these disciplines is clearly what allows us to bring the highest quality of care to our patients.

    My promise to my patients is clear for all to read here. I, with Gods help, will do what ever it takes to assist you in your recovery. I too will draw upon all the specialist in this town to find you the collaborative care that is required with the disorders being tended to.

    With Great Regards to you.
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  • Truide Torres
    Executive Director / Patient Liason
    Phone:   9152526149
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    Director: Patient Relations Advocate Dept.
    Truide has been working for the past 20 years in claims resolutions. She works hand in hand with patients and is availible to resolve dispute resolutions.

    Truide Torres (Bio)
    Driven by the passion of doing what is in the best interest of the patient, I wake up every morning with the drive to help those in need. The claims process for health care is full of pits, valleys and difficult obstacles designed to strike fear in those in need. My duty is to do what is within the confines of the law, "what ever it takes" to get those involved to pay attention to those who need help. That is what I am honored to do for our patients.

    Personally, I have seen great injustices transpire on those that do NOT have a voice. Whether, a language barrier or just not knowing the rules. My job is to find out how I can help. If I personally can not help, I will find the right sources to open the possibilities. I get the job done.

    As a wife and mother of 2 children, 3 dogs and 2 Cats. My passion is for God, Family and the mission of serving my fellow man.

    Let it be clearly stated... I am here to help. My phone 915-850-0900
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  • Daniel Alvarado
    Exercise Physiologist
    Phone:   9152038122
    Email:     daniel@push4fitness.com

    Daniel Alvarado is the owner and the top trainer at PUSHasRx® CrossFit Fitness Facility. Since becoming a Trainer Daniel has kept up to date on many continuing educational classes, ensuring that his clients receive the most comprehensive and advanced training. Working directly with the Doctors, he develops and collaborates on care plans that are patient specific. No patient ever gets the same clinical protocol. His expert clinical kinesiology experience spans over 2 decades. He has trained injured patients and NCAA National Champion Athletes. His technical ability to create programs that are clinically sound and second to none. He too has used his physical therapy and recovery experience to take broken top tier athletes into strict recovery protocols assisting them to achieve highly competitive national championships. He certainly will not admit it but, he is a top national champion trainer. Daniel, also develops youth programs that are sport specific to aid young athletes achieve great success. His mastery of clinical recovery is applied applied to all patients and top tier athletes alike. All patient programs are specifically designed with patient focused recovery priorities. He is happily married to beautiful Victoria Alvarado has one child. He enjoys strength training, movies, singing, conducting, writing poetry and being a CrossFit champion. Just a way cool dude. We think you will agree.
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  • Dennise Acosta
    Head Office Manager
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    Email:     dennis@elpasobackclinic.com

    Dennise has been at Injury Medical & Chiropractic Clinic for four years. Known as the master multi-tasker. Dennise, handles patient care from the moment you walk in the door. She is akin to the air traffic controller. She will assist you in matter requiring clinical preparation and effective inter-office communication. She unifies all department and clinical providers making sure all important information reaches all clinicians in a timely manner. She also loves to work out, stay in shape, watch movies and help people.
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    Sandra has been working at Injury Medical & Chiropractic Clinic for over 5 years. As the head Licensed Massage Therapist, she manages and directs critical aspect of clinical care. The patients love her ability to make you laugh while removing those pesky trigger points causing pain. She is able to relax and bring comfort to all she touches. There just simply is no patient that escapes her talented touch. Trained in advance myofascial techniques, she is an integral part of patient recovery. You will never see anything but a kind smile and resolute persona ready to correct your condition and aid in your recovery. She definitely enjoys helping people, has 1 dog and loves movies. She loves flowers too.
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    Billing Agent
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    Alejandra works in accounts & billing. She is the radar of the bunch. Nothing appears to escape her mind. Highly intelligent and appears not to need a computer for recall of facts. She provides information retrieval for patients and clinical staff. She has been at Injury Medical & Chiropractic Clinic for three years and ready for any task at hand. She performs interoffice communications with attorneys and medical director of ancillary offices. She loves her family and places know how to prioritize well.
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  • Mike Contreras
    Personal Trainer
    Phone:   915-203-8122

    Big Mike was born and raised in El Paso and is an excellent personal trainer and CrossFit coach. Mike works hand in hand with each patient’s clinical care plan in order to achieve optimal outcomes. A trusted clinical representative of the PUSHasRx System along with his advance protocols. Mike not only trains the injured and recovering. Mike is a sincere human that has great talent of brining out the best in every individual he works with. He will never admit it, but we will share with you a secret. He with his God given talents trains the greatest athletes and champions in El Paso. Many champions in our community know of his commitment. As a youth, he also played football (wide receiver), basketball, and track at Bel Air High School. Educated in Clinical Human Kinesiology at UTEP and loves playing football and basketball with his little nephews in his free time. Mike has three sisters and one brother, most of which live nearby in El Paso. When he’s not watching the Cowboys or Spurs play, he’s usually lifting, sleeping or watching movies. We are blessed to have this soul on our team.
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  • Alexander Isaiah Jimenez
    Collegiate Athletic Consultant & NCAA Wrestling Champion
    Phone:   915-820-9443
    Email:     alexanderijimenez@outlook.com

    Alexander Isaiah Jimenez leads the power and agility education programs for the high school athletes. While still studying for his medical degree he provides physical performance testing in order to collaborate with clinicians. He is gifted in creating physical performance programs no matter what the clinical presentation is. As national fitness champion and collegiate wrestler, he too understands what performing at high levels entails. He too has had to recover from debilitating injuries only to return better then before an win national titles. He understand how the recovery process is different for clients, patients and extreme athletes. We are blessed to have his counsel.
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    • Agility Coach
    • Mentor
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  • Ethan Padilla
    Personal Trainer & Strength Coach
    Phone:   915-203-8122

    Ethan was born and raised in El Paso and is one of our most outgoing and friendly coaches. Ethan earned his nickname “rampage Ethan” from his years at El Dorado High School, where he played inside linebacker. He has placed twice in the Strongman Competition and also recently competed in the Desert Games with his fellow PUSH Athletes as a team and placed 4th overall! Ethan is currently pursuing his Bachelor’s Degree in Kinesiology at UTEP. His focus on clients is obvious to all. Ethan is able to manage very large groups of individuals like no other. His awareness of the dangers while exercising is his greatest concern. When he’s not coaching or studying for class, he likes to spend time with his family (who are here in El Paso) or with his weimaraner puppy. Fun fact: Ethan loves any food with sprinkles (especially donuts with sprinkles) and is a diehard Seattle Seahawks fan.
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  • Andres
    Recovery & Nutrition

    Andres has been at PUSHasRx for two years. He brought his company Recovery and became the official juicer. Andy will fix you right up. Andres, will make sure that your nutritional recovery programs fits within your standards. Also, there is great care in making sure the nutritional requirement are clinically met. Patients and high performance athletes depend on high performance nutritions. Upon your completion of the physical medicine portion of therapy you will be offered specialized organic recovery drinks and supplementation to help aid in your recovery. You will be confident that from your pushing to recovery, you will be taken care of.
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    • Recovery Inc.
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  • Iylene Avalos
    PUSHasRx Trainer
    Phone:   915-203-8122

    ylene has been working with us for over 4 years. In her spare time she enjoys working out and running. She has 2 dogs and loves movies. Iylene is extremely aware of body mechanics and mindfully watches rehabilitation movements. She is always standing ready to assist and respond to client needs. Her commanding voice is always clear to all, no matter what floor you are on. Iylene is always ready and willing to answer any question you may have regarding fitness and recovery.
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  • Rick Cano
    Personal Trainier Level V
    Phone:   915-203-8122

    Most early-rising PUSHasRx members know Rick well as a fantastic coach who focuses strongly on form and will always make you laugh. He was born and raised in El Paso and loves to train his athletes and coach CrossFit. Rick is a very diligent, kind and considerate trainer. He is always mindful of client techniques and aware of client goals. When he’s not coaching, Rick loves to work on cars, especially his ’69 Chevelle (his next car will hopefully be a ’69 Charger). He not only became a certified Automotive Mechanic at 17, but while working on his certification at EPCC, he won 1st place in a bench competition when he was 16 (approx. 56 reps at 155#). His favorite movements are clean & jerks and snatches. He loves oreos (eats them every night), loves watching the CrossFit games, and loves his three bulldogs. He spent one year full-time personal training before he started coaching CrossFit two years ago. He is CrossFit Level 1 Certified and hopes to get his Level 2 Certification soon. Rick has competed in several competitions, including WOD for Toys in 2014, where his team placed 1st.
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    Education:
    • Physical Fitness Trainer
    Affiliations and Certifications:
    • Crossfit Lever I,II,III
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  • Astrid Ornelas
    Blogger/Research/Curator
    Phone:   915-850-0900

    Astrid has been at Injury Medical & Chiropractic Clinic for about three years. Astrid has taken her love for writing to an new level. She is a gifted and talented copywriter able to create amazing storylines. She creates content for patient consumption. She is able to bring words to life in a way that perplexes even the elite authors of the day. She loves nutrition and the healing power of clean eating. A naturalist at heart you will never see her eating processed foods that would be contra to clean living. She enjoys movies and creating storylines for Anime.
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    Education:
    • Literature Graduate
    Services Provided:
    • Insight Analyst
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  • Adam
    Videographer & Graphics Specialist
    Phone:   915-850-0900

    Adam has been at Injury Medical & Chiropractic Clinic for about a year. He enjoys designing and various forms of art. A story teller by trade he can see things people don’t see until his masterpieces are revealed. Adam is a director of many medias using the top graphics, audio and video medias to tell the story of our patient. Modest to the core, you would never know what he is about to create. We are blessed to have his talents telling the world about Chiropractic using any and all medias available.
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    Education:
    • Graphics Artist
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Treatment Methods
Dr. Jimenez uses the following methods to treat patients.
  • Our Passions
    Email:     doctorback@gmail.com

    We Welcome You 👊🏻.
    Purpose & Passions: I am a Doctor of Chiropractic specializing in progressive cutting-edge therapies and functional rehabilitation procedures focused on clinical physiology, total health, functional strength training and complete conditioning. We focus on restoring normal body functions after neck, back, spinal and soft tissue injuries.

    We use Specialized Chiropractic Techniques, Balanced Diet Plans, Agility Training programs, Cross-Fit techniques, the PUSH-Rx Rehabilitation System and a highly specialized program for our Veterans.

    We've been blessed to use our methods with thousand of El Pasoans over the last 27 years. This has allowed us to improve health and restore true fitness through researched non-surgical methods and wellness programs. These programs are natural and use the body's own ability to achieve goals of improvement, rather than introducing harmful chemicals, controversial hormone replacement, surgery, or addictive drugs. We want you to live a life that is fulfilled with more energy, positive attitude, better sleep, less pain, proper body weight and informed on how to maintain this way of life.

    As an extension to dynamic rehabilitation, we too offer our patients, disabled veterans, athletes, young and elder a diverse portfolio of strength equipment, high performance exercises and advanced agility options. We are very proud to have teamed up with the cities premier therapist and trainers in order to provide high level competitive athletes the option to push themselves to their highest abilities within our facility.

    Come learn how to improve your health for yourself and your loved ones.

    With a bit of work, we can achieve optimal health together, no matter the age or disability.

    Its all about: LIVING, LOVING & MATTERING! 🍎

    God Bless

    2 CONVENIENT LOCATIONS:

    (LOCATION#1) CENTRAL ELPASO:
    6440 Gateway East, Suite B

    (LOCATION#2) EAST SIDE ELPASO:
    11860 Vista Del Sol, Suite 128

    PHONE: 915-850-0900 ✔️
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