{
  "resourceType": "ActivityDefinition",
  "id": "banded-ankle-df-mobilization",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/banded-ankle-df-mobilization",
  "version": "1",
  "name": "BandedAnkleDfMobilization",
  "title": "Banded Ankle Dorsiflexion Mobilization",
  "status": "draft",
  "experimental": true,
  "description": "Standing lunge with resistance band around distal tibia pulling posteriorly. Knee drives forward over toes. Facilitates posterior talar glide. Joint mobilizations produce ES 0.34-0.41 for DF ROM in chronic ankle instability. Combined Mulligan and Maitland mobilizations show Cohen's d=1.45 for functional performance.",
  "useContext": [
    {
      "code": {
        "system": "http://terminology.hl7.org/CodeSystem/usage-context-type",
        "code": "user"
      },
      "valueCodeableConcept": {
        "text": "difficulty: beginner"
      }
    }
  ],
  "topic": [
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "banded-ankle-df-mobilization",
          "display": "Banded Ankle Dorsiflexion Mobilization"
        }
      ]
    }
  ],
  "bodySite": [
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "ankle",
          "display": "Ankle"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "70258002",
          "display": "Structure of ankle joint"
        }
      ],
      "text": "Ankle"
    }
  ],
  "kind": "ServiceRequest",
  "dosage": [
    {
      "text": "3-4×6-10 reps per ankle, daily. 6 sessions of manual therapy needed for significant strength/balance/function improvements [Martin 2021]"
    }
  ],
  "usage": "Evidence: moderate. Mechanism: posterior talar glide increases joint space and reduces mechanical restriction. Short-term ROM improvements documented [Vallandingham 2019]",
  "note": [
    {
      "text": "Heel anchored, knee tracks forward — dorsiflexion lives at the joint line",
      "authorString": "focus:internal"
    },
    {
      "text": "Drive the knee toward the wall in front of you",
      "authorString": "focus:external"
    },
    {
      "text": "Let the band drag the tibia forward as the knee travels",
      "authorString": "focus:external"
    },
    {
      "text": "Heel stays glued to the floor throughout",
      "authorString": "focus:tactile"
    }
  ],
  "relatedArtifact": [
    {
      "type": "citation",
      "label": "kisner-therapeutic-2017",
      "citation": "Kisner C, Colby LA, Borstad J. (2017). Therapeutic Exercise: Foundations and Techniques"
    },
    {
      "type": "citation",
      "label": "acsm-guidelines-2021",
      "citation": "American College of Sports Medicine. (2021). ACSM's Guidelines for Exercise Testing and Prescription",
      "document": {
        "url": "https://doi.org/10.4135/9781412994149.n165"
      }
    }
  ],
  "extension": [
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Tibialis Anterior"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "73508007"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Gastrocnemius"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "35616000"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Soleus"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "78376008"
          }
        }
      ]
    }
  ]
}