Rehabilitative Sports After Traumatic Brain Injury: How Adaptive Activities, Integrative Chiropractic Care, and Nurse Practitioners Work Together

 

Traumatic brain injuries (TBIs) can change how a person walks, thinks, feels, and connects with others. Many people are told to “rest” after a head injury, but staying inactive for too long can weaken muscles, slow balance recovery, and increase anxiety and depression. Safe, supervised rehabilitative sports and adaptive activities can help people with TBI rebuild strength, confidence, and independence. BrainLine+1

At the same time, it is not safe to jump into heavy exercise without a plan. This is where integrative chiropractic care and nurse practitioners (NPs) come in. Together, they help:

• Check that activities are safe for the brain and spine

• Manage pain, dizziness, and fatigue

• Match each sport or activity to the person’s current abilities

• Adjust the plan as the brain heals over time integrativechiropractic.net+1

Dr. Alexander Jimenez, DC, APRN, FNP-BC, often uses a mix of aerobic exercise, strength training, balance work, and cognitive drills for head-injured patients, while closely monitoring symptoms and spine alignment to ensure progress stays safe and steady.  El Paso, TX Doctor Of Chiropractic+1

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Why Rehabilitative Sports Matter After a TBI

Adaptive sports are regular sports that are modified (or “adapted”) so people with disabilities, including those with TBI, can take part. That might mean using a different wheelchair, adding extra safety gear, or changing rules to reduce the risk of falls or head injuries. BrainLine+1

Key benefits of adaptive and rehabilitative sports after TBI:

• Physical benefits

  • Build strength in legs, arms, and core

  • Improve balance, posture, and coordination

  • Increase heart and lung fitness

  • Reduce stiffness and muscle tightness Flint Rehab+1

• Brain and cognitive benefits

  • Challenge memory, attention, and reaction time

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

  • Improve dual-tasking (moving and thinking at the same time) Flint Rehab+1

• Emotional and social benefits

  • Lower anxiety and depression

  • Provide routine, goals, and structure

  • Create friendships and teamwork

  • Reduce isolation and support a sense of purpose BrainLine+1

Research on adaptive sports shows improved overall quality of life, better mood, and increased physical activity among people with disabilities, including those with TBI. PMC+1

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Safety First: Getting Ready for Adaptive Sports

Before starting any sport or rehab activity after a TBI, safety is the first priority.

Important safety steps:

• Get a full medical and neurological check from a nurse practitioner or physician

• Make sure serious conditions like brain bleeds, uncontrolled seizures, or severe heart problems are not present

• Have vision, balance, and neck mobility tested, often by an integrative chiropractor and rehab team Flint Rehab+1

• Start with low-intensity activities and progress very slowly

• Stop and get checked if symptoms worsen, such as:

  • Strong headache

  • New dizziness or double vision

  • Confusion or behavior changes

  • Nausea or vomiting

Protective equipment may include:

• Helmets or headgear for cycling, paddling, or wheelchair sports

• Supportive braces for weak joints

• Properly fitted wheelchairs, walkers, or trekking poles

• Life vests for water sports

State and health agency guides for TBI recovery often stress gradual exercise, rest breaks, and close supervision as the brain heals. Flint Rehab+1

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Land-Based Rehabilitative and Adaptive Sports for People with TBI

Walking, Hiking, and Nature-Based Activities

Gentle walking and hiking can be powerful rehab tools. Even short walks around the block or on flat trails can help restore strength, balance, and confidence.

Benefits of walking and hiking:

• Improves leg strength and coordination

• Challenges are balanced in a controlled way

• Supports mood and reduces stress, especially in nature

• Can be adapted with canes, trekking poles, or a support person krysalisconsultancy.co.uk+1

Ideas for adapted walking and hiking:

• Short, slow walks on smooth, predictable surfaces

• Park or garden walks with benches for rest

• Hiking with:

  • Walking sticks or poles

  • A companion to offer arm support

  • Trails that have railings or wider paths

Dr. Jimenez often recommends progressive walking or treadmill programs combined with balance drills and core activation work to help patients safely return to outdoor activities. El Paso, TX Doctor Of Chiropractic+1

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Adaptive Cycling

Cycling can be adapted for people with TBI using special equipment such as:

• Tricycles for extra stability

• Hand cycles for people with leg weakness

• Tandem bikes with a partner controlling steering and speed

Why adaptive cycling helps after TBI:

• Builds endurance and leg strength

• Challenges coordination and reaction time

• Offers a sense of speed and freedom without high joint impact

• Can be done indoors on a stationary bike for added safety BrainLine+1

Chiropractors can help by checking spinal alignment, hip and knee tracking, and handlebar/seat position so the rider’s posture supports the neck and low back instead of stressing them. integrativechiropractic.net+1

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Adaptive Basketball and Wheelchair Sports

Basketball and other court sports can be adapted for wheelchair use through rule changes or smaller playing areas.

Common adaptive court sports:

• Wheelchair basketball

• Wheelchair rugby

• Seated volleyball

Benefits for TBI survivors:

• Encourage social contact and teamwork

• Improve upper body strength and quick decision-making

• Build cardiovascular fitness through intervals of movement and rest BrainLine+1

Because these sports involve quick moves and sometimes contact, nurse practitioners and chiropractors should review each athlete’s history, especially any remaining vestibular or neck issues, before play. El Paso, TX Doctor Of Chiropractic+1

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Martial Arts, Tai Chi, and Yoga

Not all sports need to be high-speed. Slow, controlled movement practices like tai chi and yoga are often recommended for TBI survivors because they combine gentle physical training with mental focus. krysalisconsultancy.co.uk+1

Benefits of tai chi and yoga after TBI:

• Improve posture and body awareness

• Challenge balance in a safe, low-impact way

• Encourage deep breathing to calm the nervous system

• Offer mindfulness, which can reduce anxiety and improve sleep

Some adaptive martial arts programs use lighter contact, more stances and forms, and careful supervision to reduce the risk of another head impact.

Chiropractic providers and NPs can:

• Screen for neck instability or severe dizziness

• Recommend modified poses or stances

• Coordinate with instructors to avoid falls or high-risk movements El Paso, TX Doctor Of Chiropractic+1

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Water-Based Rehabilitative Sports

Water supports the body and reduces joint impact, which can be ideal after TBI.

Common adaptive water activities:

• Swimming with flotation aids

• Aquatic therapy or water aerobics

• Canoeing or kayaking with stable boats and life vests

• Paddleboarding with seated or kneeling options

Benefits of water sports:

• The buoyancy reduces stress on the spine and joints

• Warm water can relax tight muscles

• Water resistance helps build strength in a gentle way

• Being in water can be calming for many people BrainLine+1

For individuals with TBI, vestibular (inner ear) problems and fear of water must be taken seriously. Nurse practitioners should review medical history, medications, and seizure risk, while chiropractors can address neck stiffness and balance issues before starting a water program. Atlas Chiropractic & Wellness Center+1

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Equine-Assisted Activities (Therapeutic Horseback Riding and Hippotherapy)

Equine-assisted therapy uses interaction with horses to support physical, emotional, and cognitive recovery. In hippotherapy, or therapeutic riding, the horse’s rhythmic movement helps the rider’s core, hips, and trunk respond and adjust. Veterans Affairs+1

Potential benefits of equine-assisted activities for TBI:

• Improve core strength and posture

• Train balance and coordination through constant small adjustments

• Provide sensory input from movement, touch, sounds, and outdoor environments

• Support emotional healing, connection, and confidence

Programs are usually run by therapists and riding instructors trained in disability support. Chiropractors can help with spine and pelvic alignment before and after rides, while NPs ensure the person’s medication, seizures, and blood pressure are stable enough for riding sessions. Veterans Affairs+1

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Home and Community Activities That Support Sports Rehab

Not every rehab activity needs to look like traditional “sports.” Many home- and community-based activities can build the same skills.

Examples of home and community rehab activities:

• Short neighborhood walks or stroller walks

• Gardening with raised beds or adaptive tools

• Light yard work, like sweeping or raking

• Active video games or music-and-movement games

• Dancing in the living room to favorite songs

• Simple ball games, balloon volleyball, or beanbag toss krysalisconsultancy.co.uk+1

Community outings—like going to the grocery store, a park, or a museum—can also help with:

• Navigation and planning

• Endurance and walking

• Noise and crowd tolerance

• Real-world problem-solving My WordPress+1

Occupational and recreational therapists often use these activities to work on balance, memory, and mood. Chiropractors and NPs can reinforce these plans in the clinic, helping families choose simple, repeatable tasks that align with the patient’s abilities and energy levels. krysalisconsultancy.co.uk+1

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How Integrative Chiropractic Care Supports Sports and Activity After TBI

Integrative chiropractic care goes beyond “cracking the neck.” It combines spinal and joint care with exercise, neuromuscular therapy, and lifestyle support.

Spinal Alignment, Posture, and Pain Management

After a TBI—especially one tied to a car crash or sports hit—many people also have neck and back injuries. These can cause headaches, dizziness, and poor posture, which make exercise harder. El Paso, TX Doctor Of Chiropractic+1

Chiropractors can:

• Check the alignment of the neck, mid-back, and lower back

• Use gentle adjustments or mobilization to restore motion

• Reduce muscle tension and nerve irritation

• Teach posture strategies for walking, cycling, or paddling

Clinics like Dr. Jimenez’s in El Paso focus on restoring mobility, structural balance, and safe movement patterns, especially for people recovering from accidents and sports injuries. El Paso, TX Doctor Of Chiropractic+1

Balance, Vestibular, and Coordination Training

Many people with TBI struggle with:

• Dizziness

• Vertigo

• “Foggy” balance

• Trouble walking in a straight line

Chiropractic neurology and balance-focused care can include:

• Gaze stabilization drills

• Head and eye movement exercises

• Balance board or foam pad training

• Walking patterns that slowly increase complexity

These exercises can be paired with sports-like tasks—such as catching a ball while standing on a stable surface—to prepare patients for adaptive basketball, hiking, or cycling. Atlas Chiropractic & Wellness Center+1

Guided Exercise and Sports-Ready Rehab

Many integrative chiropractors design step-wise rehab programs that build the skills needed for sports:

• Early stage: gentle range-of-motion and walking

• Middle stage: strength and core exercises, light balance drills

• Later stage: sport-specific drills like dribbling a ball, pedaling a bike, or paddling motions

Dr. Jimenez’s clinical approach uses aerobic, strength, balance, and cognitive exercises in planned stages, so patients can safely move from basic rehab to recreational sports. El Paso, TX Doctor Of Chiropractic+1

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How Nurse Practitioners Support Safe, Effective Sports Participation

Nurse practitioners (NPs) play a central role in making sure rehab sports are medically safe and coordinated.

Comprehensive Health and Medication Management

NPs can:

• Review imaging, lab work, and specialist reports

• Check blood pressure, heart rate, and other vital signs

• Adjust medications for headaches, mood, seizures, or muscle spasticity

• Watch for side effects like dizziness or fatigue that could affect sports participation Flint Rehab+1

If a patient wants to start adaptive cycling, for example, the NP can:

• Make sure seizures are controlled

• Review if pain or mood medications cause drowsiness

• Set safe heart-rate ranges for exercise

Care Coordination and Referrals

NPs often act as the “hub” of the rehab team, coordinating:

• Neurology, psychiatry, and neuropsychology

• Physical, occupational, and speech therapy

• Integrative chiropractic and physical medicine providers

• Community adaptive sports programs and support groups, Flint Rehab+1

They help set realistic goals, share progress notes, and ensure that everyone stays on the same page about:

• Which sports are safe

• How quickly can activity increase

• Which warning signs mean “stop and re-check”

Education and Self-Management

NPs also teach patients and families how to:

• Monitor symptoms during and after exercise

• Use pacing (activity-rest cycles) to avoid crashes in energy

• Stay hydrated and choose brain-friendly nutrition

• Manage sleep, stress, and mental health while returning to active life Atlas Chiropractic & Wellness Center+1

Integrative NPs working with chiropractors can also suggest nutritional strategies, supplements, and lifestyle changes to support brain healing, pain control, and inflammation management.

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How Chiropractors and Nurse Practitioners Work Together in TBI Sports Rehab

When integrative chiropractors and nurse practitioners collaborate, patients get a more complete and safer plan.

Team-based support can include:

• Shared assessment

  • NP reviews medical and brain imaging

  • A chiropractor evaluates the spine, posture, and movement

• Joint planning

  • Decide which sports are safe now (for example, walking and swimming)

  • Set future goals (like adaptive cycling or wheelchair basketball)

• Ongoing monitoring

  • Regular check-ins on symptoms, mood, and function

  • Adjust exercise and sports intensity based on progress

• Return-to-play guidance

  • Step-wise increases in time, distance, or complexity

  • Clear rules for what to do if symptoms return or worsen El Paso, TX Doctor Of Chiropractic+1

Dr. Jimenez’s clinical model shows how a dual-licensed provider (DC and APRN) can blend these roles—offering both spinal rehab and primary-care-level oversight—to guide patients safely from the clinic back to community sports and recreation. El Paso, TX Doctor Of Chiropractic+1

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Building a Personalized Adaptive Sports Plan After TBI

Every TBI is different. A strong rehab plan respects each person’s current abilities, goals, and life roles.

Steps to building a personalized plan:

• Start with a detailed evaluation

  • Symptoms, medical history, and imaging

  • Strength, balance, and endurance

  • Emotional health and cognitive skills

• Choose low-risk starting activities

  • Seated exercises, short walks, gentle stretching

  • Simple balance drills with support

  • Light stationary cycling or water walking

• Add adaptive sports gradually

  • Move from basic walking to hiking with a partner

  • From a stationary bike to outdoor adaptive cycling

  • From individual drills to group sports like wheelchair basketball

• Use SMART goals

  • Specific, Measurable, Achievable, Relevant, Time-bound

  • Example: “Walk 10 minutes on a flat trail, 3 times per week, for 4 weeks with no spike in symptoms.”

• Review and adjust

  • Regular visits with the NP and chiropractor

  • Update goals when the patient gets stronger

  • Pull back or change activities if symptoms flare Flint Rehab+1

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Final Thoughts: Moving Forward With Confidence

Rehabilitative sports and adaptive activities can be a powerful part of traumatic brain injury recovery. From adaptive basketball and cycling to swimming, canoeing, tai chi, hiking, and equine-assisted therapy, these activities help rebuild the body, sharpen the mind, and restore a sense of identity and joy. BrainLine+1

When integrative chiropractic care and nurse practitioners are part of the team, patients are more likely to:

• Stay safe

• Progress at the right speed

• Receive coordinated care for both brain and body

• Reconnect with their community through meaningful movement

With a thoughtful plan, regular check-ins, and support from their rehab team, people living with TBI can move from fear and uncertainty toward strength, participation, and confidence in sports and daily life.

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References

BrainLine. (n.d.). Adaptive sports. BrainLine

BrainLine. (2022, May 10). The healing power of adaptive sports for people with TBI, PTSD, spinal cord injury, and other challenges. BrainLine

Flint Rehab. (n.d.). Activities for brain injury patients: 15 fun, therapeutic options. Flint Rehab

Isidoro-Cabañas, E., et al. (2023). Benefits of adaptive sport on physical and mental quality of life in adults with physical disabilities. PMC

Lape, E. C., et al. (2017). Participant-reported benefits of involvement in an adaptive sports program. PMC

Krysalis Consultancy. (n.d.). 200 activities for brain injury survivors and their families. krysalisconsultancy.co.uk+1

Integrative Chiropractic. (n.d.). The power of rehabilitation in chiropractic care: Enhancing recovery and preventing re-injury. integrativechiropractic.net

Atlas Chiropractic & Wellness Center. (2025). Natural recovery from concussion and TBI. Atlas Chiropractic & Wellness Center+1

Memorial Hermann TIRR. (n.d.). Adapted sports. memorialhermann

Warrior Allegiance. (n.d.). The benefits of adaptive sports for veterans with disabilities. Warrior Allegiance

Encompass Health. (n.d.). Community outings for individuals with brain injuries.

Assured Assisted Living. (n.d.). Physical rehabilitation activities that aid brain injury recovery.

Illinois Department of Central Management Services. (n.d.). Traumatic brain injury recovery: Get moving.

Brain Injury Center. (n.d.). Adaptive recreational activities for people with brain injury.

Brain Injury Center. (n.d.). Recreation and community participation after brain injury.

Talented Ladies Club. (n.d.). Adaptive sports and recreation for people with paralysis: How to stay active.

Flint Rehab. (n.d.). Recreational therapy activities for brain injury patients.

HML Functional Care. (n.d.). How chiropractic neurology supports brain healing.

Atlas Wellness. (n.d.). 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.

Injury 2 Wellness. (n.d.). Optimizing recovery: Chiropractic exercises for injury rehabilitation.

Jimenez, A. (2025, Nov 4). Rehabilitation exercises after head injuries — Step-by-step plan. El Paso, TX Doctor Of Chiropractic

Jimenez, A. (2025, Nov 6). Mobility & flexibility after head injuries: Chiropractic & rehab. El Paso, TX Doctor Of Chiropractic

Jimenez, A. (2025, Nov 6). Sports head injuries: Chiropractic’s role. El Paso, TX Doctor Of Chiropractic

Jimenez, A. (n.d.). El Paso, TX doctor of chiropractic. El Paso, TX Doctor Of Chiropractic

Atlas Wellness. (n.d.). How we help – chronic disease relief: Natural recovery from concussion and TBI. Atlas Chiropractic & Wellness Center+1