{
  "resourceType": "ActivityDefinition",
  "id": "bird-dog",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/bird-dog",
  "version": "1",
  "name": "BirdDog",
  "title": "Bird Dog Exercise",
  "status": "draft",
  "experimental": true,
  "description": "Quadruped exercise: simultaneously extend opposite arm and leg while maintaining a neutral spine. Activates lumbar erector spinae (29% nEMG) and multifidus while promoting anti-rotation core stability. Well-tolerated, functional, and progresses from basic to advanced levels.",
  "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": "bird-dog",
          "display": "Bird Dog Exercise"
        }
      ]
    }
  ],
  "bodySite": [
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "lumbar-spine",
          "display": "Lumbar Spine"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "23526008",
          "display": "Structure of lumbar intervertebral disc"
        }
      ],
      "text": "Lumbar Spine"
    },
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "hip",
          "display": "Hip"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "24136001",
          "display": "Structure of hip joint"
        }
      ],
      "text": "Hip"
    },
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "shoulder",
          "display": "Shoulder"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "85537004",
          "display": "Structure of glenohumeral joint"
        }
      ],
      "text": "Shoulder"
    }
  ],
  "kind": "ServiceRequest",
  "dosage": [
    {
      "text": "3×8-10 reps per side with 5-10 second holds"
    }
  ],
  "usage": "Evidence: strong. Glute max ~40-56% MVIC; erector spinae 29% nEMG; lowest L/G ratio (1.21) indicating good local muscle targeting [Ekstrom 2007, Khosrokiani 2021]",
  "note": [
    {
      "text": "Long, neutral spine — deep core stays quietly engaged",
      "authorString": "focus:internal"
    },
    {
      "text": "Reach the hand and the heel toward opposite walls",
      "authorString": "focus:external"
    },
    {
      "text": "Keep the lower back level enough to balance a glass of water",
      "authorString": "focus:external"
    },
    {
      "text": "Trace a long, flat horizon from fingertip to heel",
      "authorString": "focus:imagery"
    }
  ],
  "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"
      }
    },
    {
      "type": "citation",
      "label": "calatayud-core-tolerability-2019",
      "citation": "Calatayud J, Escriche-Escuder A, Cruz-Montecinos C, et al.. (2019). Tolerability and Muscle Activity of Core Muscle Exercises in Chronic Low-Back Pain",
      "document": {
        "url": "https://doi.org/10.3390/ijerph16193509"
      }
    },
    {
      "type": "citation",
      "label": "kim-lumbar-stabilization-emg-2016",
      "citation": "Kim CR, Park DK, Lee ST, Ryu JS. (2016). Electromyographic Changes in Trunk Muscles During Graded Lumbar Stabilization Exercises",
      "document": {
        "url": "https://doi.org/10.1016/j.pmrj.2016.05.017"
      }
    },
    {
      "type": "citation",
      "label": "ekstrom-core-rehab-emg-2007",
      "citation": "Ekstrom RA, Donatelli RA, Carp KC. (2007). Electromyographic Analysis of Core Trunk, Hip, and Thigh Muscles During 9 Rehabilitation Exercises",
      "document": {
        "url": "https://doi.org/10.2519/jospt.2007.2471"
      }
    },
    {
      "type": "citation",
      "label": "khosrokiani-core-stabilization-2021",
      "citation": "Khosrokiani Z, Letafatkar A, Sheikhi B, et al.. (2021). Hip and Core Muscle Activation During High-Load Core Stabilization Exercises",
      "document": {
        "url": "https://doi.org/10.1177/19417381211015225"
      }
    }
  ],
  "extension": [
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Erector Spinae Group"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "44947003"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Multifidus"
        },
        {
          "url": "role",
          "valueCode": "stabilizer"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "5709001"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Gluteus Maximus"
        },
        {
          "url": "role",
          "valueCode": "secondary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "206007"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Anterior Deltoid"
        },
        {
          "url": "role",
          "valueCode": "secondary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "35259002"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Transversus Abdominis"
        },
        {
          "url": "role",
          "valueCode": "stabilizer"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "86493009"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "External Oblique"
        },
        {
          "url": "role",
          "valueCode": "stabilizer"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "1179024003"
          }
        }
      ]
    }
  ]
}