Adaptive Sports After TBI: A Path to Healing

Adaptive Sports After Traumatic Brain Injury (TBI): How Sports, Nurse Practitioners, and Integrative Chiropractic Care Work Together

Traumatic brain injuries (TBIs) change how a person moves, thinks, and feels. Many people are told to “rest,” but staying still for too long can lead to stiffness, weakness, low mood, and loss of confidence. Carefully chosen sports and adaptive activities can help the brain and body recover, especially when guided by a team that includes a nurse practitioner and an integrative chiropractor.

This article explains how sports like adaptive basketball, cycling, swimming, canoeing, tai chi, hiking, and adaptive water sports can support TBI recovery, and how nurse practitioners and integrative chiropractic care work together to keep these activities safe and effective.

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Why Movement and Sports Matter After a TBI

After a TBI, the brain’s normal communication with the muscles and joints can be disrupted. This may cause:

• Poor balance

• Weakness and fatigue

• Changes in coordination

• Slower thinking, memory problems, or poor concentration

Rehabilitation exercises and activities help the brain “rewire” itself through a process called neuroplasticity. Repeated, meaningful movement helps the brain form new pathways and strengthen old ones, improving both physical and cognitive function (Illinois Department of Central Management Services [CMS], 2025). Central Management Services

According to TBI recovery resources, simple home exercises such as seated marching, weight shifts, trunk flexion and extension, and heel/toe raises can already stimulate this brain rewiring. When patients are ready, sports add more challenge, fun, and motivation on top of these basics. Central Management Services

Key benefits of sports after TBI include:

• Improved strength, balance, and coordination

• Better mood and decreased anxiety or depression

• Increased confidence and independence

• Social connection and a sense of purpose

• Support for cognitive skills like focus, planning, and memory (BrainLine, n.d.-a; Flint Rehab, n.d.). BrainLine+1

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What Are Adaptive Sports?

Adaptive sports are regular sports that have been modified so people with disabilities—including TBI, PTSD, spinal cord injuries, and paralysis—can participate safely and confidently. BrainLine+1

They may involve:

• Specialized equipment (wheelchairs for basketball, sit-skis, recumbent bikes)

• Rule changes (shorter game time, more breaks, smaller playing area)

• Extra coaching or supervision

BrainLine explains that adaptive sports often mirror common sports—such as biking, basketball, hiking, kayaking, martial arts, swimming, tennis, and water sports—but are adapted to each person’s physical and cognitive needs (BrainLine, n.d.-a; McDonough, n.d.). BrainLine+1

Examples of adaptive or modified sports for TBI recovery:

• Adaptive basketball or wheelchair basketball

• Cycling or recumbent biking

• Swimming and aquatic therapy

• Kayaking or canoeing

• Martial arts with safety modifications

• Hiking on accessible trails

• Therapeutic horseback riding/hippotherapy

These activities are not just “exercise.” They are a way to rebuild identity, community, and hope.

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How Adaptive Sports Help the Brain and Body Heal

Research and clinical experience show that adaptive sports can improve both physical and emotional well-being for people with TBI and PTSD. BrainLine+1

Physical benefits:

• Better muscle strength and endurance

• Improved balance and coordination

• Reduced pain and stiffness

• Improved cardiovascular health and energy

Cognitive and emotional benefits:

• Enhanced attention, planning, and multitasking

• Improved mood and decreased isolation

• Greater self-esteem and sense of purpose

• Stronger connection to peers and community (McDonough, n.d.; BrainLine, n.d.-a). BrainLine+1

Activities like hiking, cycling, and camping in nature can be especially calming and grounding. Nature-based activities such as fishing, hiking, and camping have been described as restorative both physically and emotionally, helping people with disabilities remain active and engaged in life (Talented Ladies Club, n.d.). Talented Ladies Club

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Land-Based Sports and Activities for TBI Recovery

1. Adaptive Basketball, Cycling, and Team Sports

Team sports like adaptive basketball or wheelchair rugby offer structure, coaching, and community. They help patients work on:

• Quick decision-making

• Hand-eye coordination

• Reaction time

• Social skills and teamwork (McDonough, n.d.). BrainLine

Adaptive cycling—including recumbent bikes or tricycles—lets people start at a slow pace and gradually build endurance. Many participants report regaining a sense of independence when they can bike on their own again. BrainLine+1

2. Walking, Hiking, and Community Outings

For many TBI survivors, walking and hiking are some of the first sports-like activities they can return to. Even simple community outings—like walking in a park, visiting a museum, or shopping with supervision—help people practice real-world tasks, balance, and decision-making (Encompass Health, n.d.). Encompass Health

Benefits of walking, hiking, and community outings:

• Step-by-step exposure to real-world challenges

• Practice with fatigue management (knowing when to rest)

• Social reintegration in a supported way

• Opportunity to work on memory, navigation, and planning

Rehabilitation programs often recommend starting with short, supervised outings and slowly increasing distance, time, and complexity (Encompass Health, n.d.; Assured Assisted Living, n.d.). Encompass Health+1

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Water, Tai Chi, and Nature-Based Activities

1. Swimming and Adaptive Water Sports

Water is a powerful medium for TBI rehabilitation. Swimming and other water sports can:

• Reduce joint stress and pain

• Improve balance and coordination

• Support cardio fitness without high impact

Adaptive water sports, such as kayaking, canoeing, or paddleboarding with support, allow people with TBI to feel stable while still challenging their balance and upper-body strength (BrainLine, n.d.-a; McDonough, n.d.). BrainLine+1

2. Tai Chi and Gentle Mind-Body Exercise

Gentle activities like tai chi, yoga, or mindful movement can:

• Improve balance, posture, and joint control

• Reduce anxiety and stress

• Enhance focus and body awareness

Tai chi’s slow, flowing movements make it a strong option for people with TBI who struggle with dizziness, unsteadiness, or anxiety in fast-paced environments.

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Therapeutic Horseback Riding and Recreational Therapy

Equine-assisted therapy (therapeutic horseback riding or hippotherapy) has been studied as a supportive intervention for people with PTSD and neurological challenges. It can help with:

• Core strength and posture

• Balance and pelvic control

• Confidence and emotional regulation

• Trust and connection with another living being

Research on veterans with PTSD and other injuries suggests that horse-based therapy can improve emotional well-being and function (e.g., equine-assisted therapy case series). BrainLine

Recreational therapy in general—such as adaptive sports, music-based activities, and even gardening—helps patients stay active and engaged while working toward physical and cognitive goals (Flint Rehab, n.d.). Flint Rehab

Examples of brain-friendly recreational activities:

• Gardening or light yard work

• Music-based games or rhythm exercises

• Board games that require planning and strategy

• Art, crafts, and group recreation

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Matching Sports to the Stage of TBI Recovery

Not every sport is safe for every person or at every stage of healing. A careful plan is essential.

Early stage (still easily fatigued or dizzy):

• Seated exercises (marching, trunk flexion, trunk extension)

• Gentle stretching and range of motion

• Short, supported walks

• Simple cognitive games (puzzles, journaling) Central Management Services+1

Middle stage (better endurance, but still limited):

• Stationary cycling or recumbent biking

• Light swimming or water walking

• Tai chi, gentle yoga, or guided group exercise

• Short hikes on flat, safe surfaces

Later stage (higher functioning and cleared by the medical team):

• Adaptive basketball or team sports

• Kayaking, canoeing, or adaptive water sports

• Therapeutic horseback riding

• More challenging hikes or balance tasks

Assisted living and rehab programs emphasize the importance of tailored physical activity—matching it to a person’s mobility, cognition, medical conditions, and preferences. assuredassistedliving.com+1

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The Role of Nurse Practitioners in Sports-Based TBI Rehabilitation

Nurse practitioners (NPs) play a central role in keeping TBI patients safe as they return to sports and activities.

Key responsibilities of nurse practitioners in this setting:

• Medical evaluation and clearance

  • Review imaging, neurology reports, and cognitive status

  • Screen for seizure disorders, blood pressure issues, or heart problems

  • Decide when it is safe to begin or advance sports

• Medication management

  • Adjust headache, pain, spasticity, mood, or seizure medications

  • Watch for side effects that may affect balance, alertness, or reaction time

• Care coordination

  • Communicate with physical therapists, speech therapists, neuropsychologists, and adaptive sports programs

  • Help connect patients to community resources, adaptive sports clinics, and local TBI support groups

• Monitoring and follow-up

  • Track sleep, mood, fatigue, dizziness, and pain

  • Adjust activity intensity if new symptoms appear

With this approach, NPs help ensure that sports and adaptive activities are not only inspiring but also medically safe and tailored to each person’s needs.

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How Integrative Chiropractic Care Supports TBI Recovery

Integrative chiropractors look at spinal alignment, nervous system function, posture, and movement patterns. After a TBI, especially when neck trauma is involved, the spine can become stiff or misaligned, which may worsen headaches, dizziness, and balance problems.

Chiropractic and neuromusculoskeletal approaches to concussion and TBI may include:

• Gentle adjustments to improve spinal alignment and reduce nerve irritation

• Soft tissue work to decrease muscle tension and improve blood flow

• Vestibular and balance exercises to retrain the body’s sense of position and stability Atlas Chiropractic & Wellness Center+1

Clinics that combine chiropractic care with rehabilitation exercises note that targeted exercises plus adjustments can:

• Enhance posture and spinal stability

• Improve range of motion

• Reduce pain and inflammation

• Support safer participation in sports and daily activities (Injury 2 Wellness Centers, n.d.). Injury 2 Wellness Centers

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Dr. Alexander Jimenez’s Clinical Perspective on Integrative Care and TBI

Dr. Alexander Jimenez, DC, APRN, FNP-BC, practices as both a chiropractor and a family practice nurse practitioner. His clinics focus on:

• Functional and integrative medicine, looking at the whole person—physical, nutritional, and emotional factors

• Musculoskeletal rehabilitation, using chiropractic adjustments, exercise, and complementary therapies

• Collaboration with physical medicine doctors, therapists, athletic trainers, and other specialists, El Paso, TX Doctor Of Chiropractic+1

From an integrative standpoint, Dr. Jimenez’s approach to TBI and sports-based rehab includes:

• Correcting spinal misalignments that may worsen headaches, dizziness, and balance issues

• Designing graded exercise and movement plans that match each patient’s stage of recovery

• Supporting nutrition, sleep, and overall wellness to optimize brain healing

• Working with referring physicians, attorneys (when injuries involve motor vehicle crashes or work accidents), and rehab teams to document progress and keep patients safe

By blending chiropractic techniques, nurse practitioner skills, and functional medicine, this kind of practice helps patients participate more safely in adaptive sports and physical activities that support long-term recovery.

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Building a Personalized Adaptive Sports Plan: Step-by-Step

Here is a simple framework that patients, families, NPs, and integrative chiropractors can follow together.

Step 1: Medical and Functional Assessment

• Full TBI evaluation and imaging review

• Check strength, balance, vision, and cognition

• Identify pain sources (neck, back, shoulders, etc.)

Step 2: Set Clear Goals

• Walk independently for a certain distance

• Join an adaptive basketball or cycling group

• Swim 2–3 times per week

• Hike on local accessible trails

Step 3: Choose Starting Activities

• Begin with low-impact, low-risk options (short walks, seated exercises, stationary cycling, gentle water movement)

• Add simple cognitive tasks (keeping score in a game, following multi-step directions)

Step 4: Integrate Chiropractic and Rehab Exercises

• Schedule regular chiropractic visits to address spinal alignment and pain

• Learn home exercises for posture, balance, and core strength

• Incorporate chiropractic-guided stretches and strengthening exercises into sports days (Injury 2 Wellness Centers, n.d.; Essential ChiroCare, n.d.). Injury 2 Wellness Centers+1

Step 5: Progress to Adaptive Sports

• Move from simple movements to more structured sports like swimming, adaptive basketball, or cycling

• Introduce nature-based activities such as fishing, hiking, or camping, as tolerated (Talented Ladies Club, n.d.). Talented Ladies Club

• Consider equine-assisted therapy if appropriate and available

Step 6: Monitor, Adjust, and Celebrate Wins

• Nurse practitioner monitors symptoms, vital signs, and medications

• Chiropractor tracks musculoskeletal changes and modifies treatment

• Rehab team adjusts intensity, equipment, and activity type

• Celebrate milestones—first community outing, first game, first hike, or first lap in the pool

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Practical Safety Tips for Patients and Families

Before starting or progressing sports after a TBI, it helps to keep these points in mind:

Always:

• Get medical clearance from a qualified provider (such as a nurse practitioner or physician)

• Start slowly and increase intensity one step at a time

• Use helmets, life vests, and any recommended adaptive equipment

• Warm up and cool down

Watch for warning signs:

• Worsening headaches

• New or severe dizziness

• Nausea or vomiting

• Vision changes

• Confusion, behavior changes, or extreme fatigue

If these appear, the activity should be stopped and the medical team contacted for guidance.

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Putting It All Together

Sports and adaptive activities are not just “extras” after a traumatic brain injury—they can be powerful tools for healing. Adaptive basketball, cycling, swimming, canoeing, tai chi, hiking, horseback riding, and other activities can:

• Strengthen the body

• Challenge the brain

• Lift mood and confidence

• Reconnect people to community and purpose (BrainLine, n.d.-a; McDonough, n.d.; Flint Rehab, n.d.). BrainLine+2BrainLine+2

When nurse practitioners and integrative chiropractors work together—alongside physical therapists, recreational therapists, and adaptive sports coaches—they help ensure these activities are safe, targeted, and meaningful.

With careful planning, patient-centered communication, and a step-by-step approach, many people with TBI can return to movement, sport, and activities that help them feel like their own again.

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References

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

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

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

Illinois Department of Central Management Services. (2025). Traumatic brain injury recovery.

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

Jimenez, A. (n.d.). El Paso, TX chiropractor Dr. Alex Jimenez DC | Personal injury specialist.

McDonough, V. T. (n.d.). The healing power of adaptive sports for people with TBI, PTSD, spinal cord injury, and other challenges.

My Balance Matters. (n.d.). Chiropractic care for concussions: A holistic approach to recovery and rehabilitation.

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

Essential ChiroCare. (n.d.). Regaining your function, reducing pain, and more – The benefits of physical therapy for a TBI.

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