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Nutrition’s Role In Performance Enhancement And Post Exercise Recovery

Nutrition Abstract: A number of factors contribute to success in sport, and diet is a key component. An athlete’s dietary requirements depend on several aspects, including the sport, the athlete’s goals, the environment, and practical issues. The importance of individualized dietary advice has been increasingly recognized, including day-to-day dietary advice and specific advice before, during, and after training and/or competition. Athletes use a range of dietary strategies to improve performance, with maximizing glycogen stores a key strategy for many. Carbohydrate intake during exercise maintains high levels of carbohydrate oxidation, prevents hypoglycemia, and has a positive effect on the central nervous system. Recent research has focused on athletes training with low carbohydrate availability to enhance metabolic adaptations, but whether this leads to an improvement in performance is unclear. The benefits of protein intake throughout the day following exercise are now well recognized. Athletes should aim to maintain adequate levels of hydration, and they should minimize fluid losses during exercise to no more than 2% of their body weight. Supplement use is widespread in athletes, with recent interest in the beneficial effects of nitrate, beta-alanine, and vitamin D on performance. However, an unregulated supplement industry and inadvertent contamination of supplements with banned substances increases the risk of a positive doping result. Although the availability of nutrition information for athletes varies, athletes will bene t from the advice of a registered dietician or nutritionist.

Keywords: nutrition, diet, sport, athlete, supplements, hydration

Introduction To The Importance & Influence Of Nutrition On Exercise

nutrition athlete woman appleNutrition is increasingly recognized as a key component of optimal sporting performance, with both the science and practice of sports nutrition developing rapidly.1 Recent studies have found that a planned scientific nutritional strategy (consisting of fluid, carbohydrate, sodium, and caffeine) compared with a self-chosen nutritional strategy helped non-elite runners complete a marathon run faster2 and trained cyclists complete a time trial faster.3 Whereas training has the greatest potential to increase performance, it has been estimated that consumption of a carbohydrate–electrolyte drink or relatively low doses of caffeine may improve a 40 km cycling time trial performance by 32–42 and 55–84 seconds, respectively.4

Evidence supports a range of dietary strategies in enhancing sports performance. It is likely that combining several strategies will be of greater bene t than one strategy in isolation.5 Dietary strategies to enhance performance include optimizing intakes of macronutrients, micronutrients, and fluids, including their composition and spacing throughout the day. The importance of individualized or personalized dietary advice is becoming increasingly recognized,6 with dietary strategies varying according to the individual athlete’s sport, personal goals, and practicalities (eg, food preferences). “Athlete” includes individuals competing in a range of sport types, such as strength and power (eg, weight-lifting), team (eg, football), and endurance (eg, marathon running). The use of dietary supplements can enhance performance, provided these are used appropriately. This manuscript provides an overview of dietary strategies used by athletes, the efficacy of these strategies, availability of nutrition information to athletes, and risks associated with dietary supplement intake.

Review Of Diet Strategies Employed By Athletes

nutrition healthy lady stepper

Maximizing Muscle Glycogen Stores Prior To Exercise

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Carbohydrate loading aims to maximize an athlete’s muscle glycogen stores prior to endurance exercise lasting longer than 90 minutes. Benefits include delayed onset of fatigue (approximately 20%) and improvement in performance of 2%–3%.7 Initial protocols involved a depletion phase (3 days of intense training and low carbohydrate intake) followed by a loading phase (3 days of reduced training and high carbo- hydrate intake).8,9 Further research showed muscle glycogen concentrations could be enhanced to a similar level without the glycogen-depletion phase,10 and more recently, that 24 hours may be sufficient to maximize glycogen stores.11,12 Current recommendations suggest that for sustained or intermittent exercise longer than 90 minutes, athletes should consume 10–12 g of carbohydrate per kg of body mass (BM) per day in the 36–48 hours prior to exercise.13

There appears to be no advantage to increasing pre- exercise muscle glycogen content for moderate-intensity cycling or running of 60–90 minutes, as signi cant levels of glycogen remain in the muscle following exercise.7 For exercise shorter than 90 minutes, 7–12 g of carbohydrate/kg of BM should be consumed during the 24 hours preceding.13 Some14,15 but not all16 studies have shown enhanced performance of intermittent high-intensity exercise of 60–90 minutes with carbohydrate loading.

Carbohydrate eaten in the hours prior to exercise (com- pared with an overnight fast) has been shown to increase muscle glycogen stores and carbohydrate oxidation,17 extend cycle time to exhaustion,5 and improve exercise performance.5,18 Specific recommendations for exercise of longer than 60 minutes include 1–4 g of carbohydrate/kg of BM in the 1–4 hours prior.13 Most studies have not found improvements in performance from consuming low glycemic index (GI) foods prior to exercise.19 Any metabolic or performance effects from low GI foods appear to be attenuated when carbohydrate is consumed during exercise.20,21

Carbohydrate Intake During The Event

nutrition noodles tomato carbsCarbohydrate ingestion has been shown to improve performance in events lasting approximately 1 hour.6 A growing body of evidence also demonstrates beneficial effects of a carbohydrate mouth rinse on performance.22 It is thought that receptors in the oral cavity signal to the central nervous system to positively modify motor output.23

In longer events, carbohydrate improves performance primarily by preventing hypoglycemia and maintaining high levels of carbohydrate oxidation.6 The rate of exogenous carbohydrate oxidation is limited by the small intestine’s ability to absorb carbohydrate.6 Glucose is absorbed by the sodium- dependent transporter (SGLT1), which becomes saturated with an intake of approximately 1 g/minute. The simultaneous ingestion of fructose (absorbed via glucose transporter 5 [GLUT5]), enables oxidation rates of approximately 1.3 g/minute,24 with performance benefits apparent in the third hour of exercise.6 Recommendations reflect this, with 90 g of carbohydrate from multiple sources recommended for events longer than 2.5 hours, and 60 g of carbohydrate from either single or multiple sources recommended for exercise of 2–3 hours’ duration (Table 1). For slower athletes exercising at a lower intensity, carbohydrate requirements will be less due to lower carbohydrate oxidation.6 Daily training with high carbohydrate availability has been shown to increase exogenous carbohydrate oxidation rates.25

nutrition table 1

The “Train-Low, Compete-High” Approach

nutritionThe “train-low, compete-high” concept is training with low carbohydrate availability to promote adaptations such as enhanced activation of cell-signaling pathways, increased mitochondrial enzyme content and activity, enhanced lipid oxidation rates, and hence improved exercise capacity.26 However, there is no clear evidence that performance is improved with this approach.27 For example, when highly trained cyclists were separated into once-daily (train-high) or twice-daily (train-low) training sessions, increases in resting muscle glycogen content were seen in the low-carbohydrate- availability group, along with other selected training adaptations.28 However, performance in a 1-hour time trial after 3 weeks of training was no different between groups. Other research has produced similar results.29 Different strategies have been suggested (eg, training after an overnight fast, training twice per day, restricting carbohydrate during recovery),26 but further research is needed to establish optimal dietary periodization plans.27

Fat As A Fuel During Endurance Exercise

nutritionThere has been a recent resurgence of interest in fat as a fuel, particularly for ultra endurance exercise. A high-carbohydrate strategy inhibits fat utilization during exercise,30 which may not be beneficial due to the abundance of energy stored in the body as fat. Creating an environment that optimizes fat oxidation potentially occurs when dietary carbohydrate is reduced to a level that promotes ketosis.31 However, this strategy may impair performance of high-intensity activity, by contributing to a reduction in pyruvate dehydrogenase activity and glycogenolysis. 32 The lack of performance benefits seen in studies investigating “high-fat” diets may be attributed to inadequate carbohydrate restriction and time for adaptation.31 Research into the performance effects of high fat diets continues.

Nutrition: Protein

nutrition milk drink health fat healthyWhile protein consumption prior to and during endurance and resistance exercise has been shown to enhance rates of muscle protein synthesis (MPS), a recent review found protein ingestion alongside carbohydrate during exercise does not improve time–trial performance when compared with the ingestion of adequate amounts of carbohydrate alone.33

Fluid And Electrolytes

nutrition sports woman drinking waterThe purpose of fluid consumption during exercise is primarily to maintain hydration and thermoregulation, thereby benefiting performance. Evidence is emerging on increased risk of oxidative stress with dehydration.34 Fluid consumption prior to exercise is recommended to ensure that the athlete is well-hydrated prior to commencing exercise.35 In addition, carefully planned hyperhydration ( fluid overloading) prior to an event may reset fluid balance and increase fluid retention, and consequently improve heat tolerance.36 However, fluid overloading may increase the risk of hyponatremia 37 and impact negatively on performance due to feelings of fullness and the need to urinate.

Hydration requirements are closely linked to sweat loss, which is highly variable (0.5–2.0 L/hour) and dependent on type and duration of exercise, ambient temperature, and athletes’ individual characteristics.35 Sodium losses linked to high temperature can be substantial, and in events of long duration or in hot temperatures, sodium must be replaced along with fluid to reduce risk of hyponatremia. 35

It has long been suggested that fluid losses greater than 2% of BM can impair performance,35 but there is controversy over the recommendation that athletes maintain BM by fluid ingestion throughout an event.37 Well-trained athletes who “drink to thirst” have been found to lose as much as 3.1% of BM with no impairment of performance in ultra-endurance events.38 Ambient temperature is important, and a review illustrated that exercise performance was preserved if loss was restricted to 1.8% and 3.2% of BM in hot and temperate conditions, respectively.39

Dietary Supplementation: Nitrates, Beta-Alanine & Vitamin D

nutritionPerformance supplements shown to enhance performance include caffeine, beetroot juice, beta-alanine (BA), creatine, and bicarbonate.40 Comprehensive reviews on other supplements including caffeine, creatine, and bicarbonate can be found elsewhere.41 In recent years, research has focused on the role of nitrate, BA, and vitamin D and performance. Nitrate is most commonly provided as sodium nitrate or beetroot juice.42 Dietary nitrates are reduced (in mouth and stomach) to nitrites, and then to nitric oxide. During exercise, nitric oxide potentially influences skeletal muscle function through regulation of blood ow and glucose homeostasis, as well as mitochondrial respiration.43 During endurance exercise, nitrate supplementation has been shown to increase exercise efficiency (4%–5% reduction in VO at a steady attenuate oxidative stress.42 Similarly, a 4.2% improvement in performance was shown in a test designed to simulate a football game.44

BA is a precursor of carnosine, which is thought to have a number of performance-enhancing functions including the reduction of acidosis, regulation of calcium, and antioxidant properties.45 Supplementation with BA has been shown to 2 state; 0.9% improvement in time trials), reduce fatigue, and augment intracellular carnosine concentration.45 A systematic review concluded that BA may increase power output and working capacity and decrease feelings of fatigue, but that there are still questions about safety. The authors suggest caution in the use of BA as an ergogenic aid.46

Vitamin D is essential for the maintenance of bone health and control of calcium homeostasis, but is also important for muscle strength,47,48 regulation of the immune system,49 and cardiovascular health.50 Thus inadequate vitamin D status has potential implications for the overall health of athletes and performance. A recent review found that the vitamin D status of most athletes reflects that of the population in their locality, with lower levels in winter, and athletes who train predominantly indoors are at greater risk of deficiency.51 There are no dietary vitamin D recommendations for athletes; however, for muscle function, bone health, and avoidance of respiratory infections, current evidence supports maintenance of serum 25-hydroxy vitamin D (circulating form) concentrations of 80–100 nmol/L.51

Diets Specific For Post Exercise

nutrition girl eating healthy salad after workout

Recovery from a bout of exercise is integral to the athlete’s training regimen. Without adequate recovery of carbohydrate, protein, fluids, and electrolytes, beneficial adaptations and performance may be hampered.

Muscle Glycogen Synthesis

nutritionConsuming carbohydrates immediately post exercise to coincide with the initial rapid phase of glycogen synthesis has been used as a strategy to maximize rates of muscle glycogen synthesis. An early study found delaying feeding by 2 hours after glycogen-depleting cycling exercise reduced glycogen synthesis rates.52 However the importance of this early enhanced rate of glycogen synthesis has been questioned in the context of extended recovery periods with sufficient carbohydrate consumption. Enhancing the rate of glycogen synthesis with immediate carbohydrate consumption after exercise appears most relevant when the next exercise session is within 8 hours of the first.53,54 Feeding frequency is also irrelevant with extended recovery; by 24 hours post exercise, consumption of carbohydrate as four large meals or 16 small snacks had comparable effects on muscle glycogen storage.55

With less than 8 hours between exercise sessions, it is recommended that for maximal glycogen synthesis, 1.0–1.2 g/kg/hour is consumed for the first 4 hours, followed by resumption of daily carbohydrate requirements.13 Additional protein has been shown to enhance glycogen synthesis rates when carbohydrate intake is suboptimal.56 The consumption of moderate to high GI foods post exercise is recommended;13 however, when either a high-GI or low-GI meal was consumed after glycogen-depleting exercise, no performance differences were seen in a 5 km cycling time trial 3 hours later.57

Muscle Protein Synthesis

nutritionAn acute bout of intense endurance or resistance exercise can induce a transient increase in protein turnover, and, until feeding, protein balance remains negative. Protein consumption after exercise enhances MPS and net protein balance,58 predominantly by increasing mitochondrial protein fraction with endurance training, and myofibrillar protein fraction with resistance training.59

Only a few studies have investigated the effect of timing of protein intake post exercise. No significant difference in MPS was observed over 4 hours post exercise when a mixture of essential amino acids and sucrose was fed 1 hour versus 3 hours after resistance exercise.60 Conversely, when a protein and carbohydrate supplement was provided immediately versus 3 hours after cycling exercise, leg protein synthesis increased threefold over 3 hours.61 A meta-analysis found timed post exercise protein intake becomes less important with longer recovery periods and adequate protein intake,62 at least for resistance training.

Dose–response studies suggest approximately 20 g of high-quality protein is sufficient to maximize MPS at rest,63 following resistance,63,64 and after high-intensity aerobic exercise.65 Rate of MPS has been found to approximately triple 45–90 minutes after protein consumption at rest, and then return to baseline levels, even with continued availability of circulating essential amino acids (termed the “muscle full” effect).66 Since exercise-induced protein synthesis is elevated for 24–48 hours following resistance exercise67and 24–28 hours following high-intensity aerobic exercise,68 and feeding protein post exercise has an additive effect,58,64 then multiple feedings over the day post exercise might maximize muscle growth. In fact, feeding 20 g of whey protein every 3 hours was subsequently found to maximally stimulate muscle myofibrillar protein synthesis following resistance exercise.69,70

In resistance training, where post exercise intake of protein was balanced by protein intake later in the day, increased adaptation of muscle hypertrophy resulted in equivocal strength performance effects.71,72 Most studies have not found a subsequent bene t to aerobic performance with post exercise protein consumption.73,74 However, in two well controlled studies in which post exercise protein intake was balanced by protein intake later in the day, improvements were seen in cycling time to exhaustion75 and in cycling sprint performance.76

Fluids And Electrolyte Balance

nutritionFluid and electrolyte replacement after exercise can be achieved through resuming normal hydration practices. However, when euhydration is needed within 24 hours or substantial body weight has been lost (.5% of BM), a more structured response may be warranted to replace fluids and electrolytes.77

 

 

Availability Of Nutritional Information To Athletes At Varying Levels

nutrition man and woman doing exercisesThe availability of nutrition information for athletes varies. Younger or recreational athletes are more likely to receive generalized nutritional information of poorer quality from individuals such as coaches.78 Elite athletes are more likely to have access to specialized sports-nutrition input from qualified professionals. A range of sports science and medicine support systems are in place in different countries to assist elite athletes,1 and nutrition is a key component of these services. Some countries have nutrition programs embedded within sports institutes (eg, Australia) or alternatively have National Olympic Committees that support nutrition programs (eg, United States of America).1 However, not all athletes at the elite level have access to sports-nutrition services. This may be due to financial constraints of the sport, geographical issues, and a lack of recognition of the value of a sports-nutrition service.78

Athletes eat several times per day, with snacks contributing to energy requirements.79 Dietary intake differs across sports, with endurance athletes more likely to achieve energy and carbohydrate requirements compared to athletes in weight-conscious sports.79 A review found daily intakes of carbohydrate were 7.6 g/kg and 5.7 g/kg of BM for male and female endurance athletes, respectively.80 Ten elite Kenyan runners met macronutrient recommendations but not guide- lines for fluid intake.81 A review of fluid strategies showed a wide variability of intake across sports, with several factors influencing intake, many outside the athlete’s control.82

Nutrition information may be delivered to athletes by a range of people (dietitians, nutritionists, medical practitioners, sports scientists, coaches, trainers) and from a variety of sources (nutrition education programs, sporting magazines, the media and Internet).83 Of concern is the provision of nutrition advice from outside various professional’s scope of practice. For example, in Australia 88% of registered exercise professionals provided nutrition advice, despite many not having adequate nutrition training.84 A study of Canadian high-performance athletes from 34 sports found physicians ranked eighth and dietitians, 16th as choice of source of dietary supplement information.85

Risks Of Contravening The Doping Regulations

nutrition doping syringe bloodSupplement use is widespread in athletes.86,87 For example, 87.5% of elite athletes in Australia used dietary supplements88 and 87% of Canadian high-performance athletes took dietary supplements within the past 6 months85 (Table 2). It is difficult to compare studies due to differences in the criteria used to define dietary supplements, variations in assessing supplement intake, and disparities in the populations studied.85

Athletes take supplements for many reasons, including for proposed performance benefits, for prevention or treatment of a nutrient deficiency, for convenience, or due to fear of “missing out” by not taking a particular supplement.41

The potential benefits (eg, improved performance) of taking a dietary supplement must outweigh the risks.86,87 There are few permitted dietary supplements available that have an ergogenic effect.87,89 Dietary supplementation cannot compensate for poor food choices.87 Other concerns include lack of efficacy, safety issues (toxicity, medical concerns), negative nutrient interactions, unpleasant side effects, ethical issues, financial expense, and lack of quality control.41,86,87 Of major concern, is the consumption of prohibited substances by the World Anti-Doping Agency (WADA).

Inadequate regulation in the supplement industry (com- pounded by widespread Internet sales) makes it difficult for athletes to choose supplements wisely.41,86,87 In 2000–2001, a study of 634 different supplements from 13 countries found that 94 (14.8%) contained undeclared steroids, banned by WADA.90 Many contaminated supplements were routinely used by athletes (eg, vitamin and mineral supplements).86 Several studies have confirmed these findings. 41,86,89

nutrition table 2A positive drug test in an athlete can occur with even a minute quantity of a banned substance.41,87 WADA maintains a “strict liability” policy, whereby every athlete is responsible for any substance found in their body regardless of how it got there.41,86,87,89 The World Anti-Doping Code (January 1, 2015) does recognize the issue of contaminated supplements.91 Whereas the code upholds the principle of strict liability, athletes may receive a lesser ban if they can  show “no significant fault” to demonstrate they did not intend to cheat. The updated code imposes longer bans on those who cheat intentionally, includes athlete support personnel (eg, coaches, medical staff), and has an increased focus on anti-doping education.91,99

In an effort to educate athletes about sports-supplement use, the Australian Institute of Sport’s sports-supplement program categorizes supplements according to evidence of efficacy in performance and risk of doping outcome.40 Category A supplements have sound evidence for use and include sports foods, medical supplements, and performance supplements. Category D supplements should not be used by athletes, as they are banned or are at high risk for contamination. These include stimulants, pro-hormones and hormone boosters, growth hormone releasers, peptides, glycerol, and colostrum.40

Conclusion

nutrition

Athletes are always looking for an edge to improve their performance, and there are a range of dietary strategies available. Nonetheless, dietary recommendations should be individualized for each athlete and their sport and provided by an appropriately qualified professional to ensure optimal performance. Dietary supplements should be used with caution and as part of an overall nutrition and performance plan.

Disclosure

The authors report no conflicts of interest in this work.

Kathryn L Beck1 Jasmine S Thomson2 Richard J Swift1 Pamela R von Hurst1

1School of Food and Nutrition, Massey institute of Food Science and Technology, College of Health, Massey University Albany, Auckland, 2School of Food and Nutrition, Massey institute of Food Science and Technology, College of Health, Massey University Manawatu, Palmerston North, New Zealand

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    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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    Education:
    • Doctor
    Affiliations and Certifications:
    • Texas Chiropractic Association
    Services Provided:
    • Chiropractic Care
    • Physical Therapy
    • Rehabiliation
    • Strength Training
    • Crossfit Doctor
    • Return to Competition Rehabilitation
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  • Truide Torres
    Executive Director / Patient Liason
    Phone:   9152526149
    Email:     truidetorres@gmail.com

    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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    Education:
    • Law Student (Matriculated)
    Affiliations and Certifications:
    • Legal Studies
    Services Provided:
    • Patient Advocate
    • Claims Managment
    • Case Management
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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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    Education:
    • Exercise Physiology
    Affiliations and Certifications:
    • Crossfit Level I,II,III ; Pilates Instructor
    Services Provided:
    • Fitness Training
    • Strength & Power Fitness
    • Mental Strength
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  • Dennise Acosta
    Head Office Manager
    Phone:   915-850-0900
    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 Martinez
    Head Clinical Therapist
    Phone:   915-850-0900
    Email:     sandra@elpasobackclinic.com

    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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    Education:
    • LMT: Licensed Massage Therapist
    Affiliations and Certifications:
    • LMT, MMT, ART
    Services Provided:
    • Massage Therapy
    • Muscle Release Techniques
    • Neuromuscular Re-education
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  • Alejandra
    Billing Agent
    Phone:   915-850-0900
    Email:     billing@elpasobackclinic.com

    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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    Education:
    • Nursing Student (Matriculated)
    Services Provided:
    • Billing
    • Medical Records
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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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    Education:
    • Exercise Physiologist
    Affiliations and Certifications:
    • Crossfit Level 3
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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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    Education:
    • Bio-Medical Science (Pre-Medical) - Matriculated
    Services Provided:
    • Strength Coach
    • 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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    Education:
    • Physical Therapy Student (Matriculated)
    Services Provided:
    • Strength Coach
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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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    Education:
    • Recovery Inc.
    Services Provided:
    • Nutrition
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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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    Education:
    • Personal Trainer
    Services Provided:
    • Personal Trainer Level I,II,III,IV
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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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