{
  "resourceType": "ActivityDefinition",
  "id": "bridge",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/bridge",
  "version": "1",
  "name": "Bridge",
  "title": "Bridge",
  "status": "draft",
  "experimental": true,
  "description": "Supine hip extension exercise. Patient lies on back with knees bent, feet flat on floor, and lifts hips toward ceiling by squeezing glutes.",
  "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": "bridge",
          "display": "Bridge"
        }
      ]
    }
  ],
  "bodySite": [
    {
      "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"
    }
  ],
  "kind": "ServiceRequest",
  "dosage": [
    {
      "text": "3×10-15 reps, 2-3x/week"
    }
  ],
  "usage": "Evidence: moderate. Glute max 20-40% MVIC; hamstrings 15-25% MVIC; single-leg variation significantly increases activation [Ekstrom 2007, Hirose 2018]",
  "note": [
    {
      "text": "Posterior pelvic tilt — glute drives the lift, low back stays quiet",
      "authorString": "focus:internal"
    },
    {
      "text": "Push the heels into the floor to lift the hips",
      "authorString": "focus:external"
    },
    {
      "text": "Drive the front of the hips toward the ceiling",
      "authorString": "focus:external"
    },
    {
      "text": "Knees stay hip-width apart against gentle hand pressure",
      "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"
      }
    },
    {
      "type": "citation",
      "label": "hirose-bridge-emg-2018",
      "citation": "Hirose N, Tsuruike M. (2018). Differences in the Electromyographic Activity of the Hamstring, Gluteus Maximus, and Erector Spinae Muscles in a Variety of Kinetic Changes",
      "document": {
        "url": "https://doi.org/10.1519/JSC.0000000000002747"
      }
    },
    {
      "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"
      }
    },
    {
      "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": "luk-bridge-suspension-2021",
      "citation": "Luk JTC, Kwok FKC, Ho IMK, Wong DP. (2021). Acute Responses of Core Muscle Activity During Bridge Exercises on the Floor vs. The Suspension System",
      "document": {
        "url": "https://doi.org/10.3390/ijerph18115908"
      }
    },
    {
      "type": "citation",
      "label": "el-melhat-bridge-hip-position-2022",
      "citation": "El Melhat AM, El Khatib A, Youssef ASA, et al.. (2022). Influence of Changing Hip Position on Electromyographic Activities of Selected Trunk Muscles During Bridging Exercises",
      "document": {
        "url": "https://doi.org/10.1016/j.jmpt.2024.08.010"
      }
    },
    {
      "type": "citation",
      "label": "choi-bridge-abduction-2015",
      "citation": "Choi SA, Cynn HS, Yi CH, et al.. (2015). Isometric Hip Abduction Using a Thera-Band Alters Gluteus Maximus Muscle Activity and the Anterior Pelvic Tilt Angle During Bridging Exercise",
      "document": {
        "url": "https://doi.org/10.1016/j.jelekin.2014.09.005"
      }
    },
    {
      "type": "successor",
      "label": "3×15 bridges with a level pelvis and no hamstring cramping",
      "display": "Single-Leg Glute Bridge",
      "resource": "ActivityDefinition/single-leg-glute-bridge"
    }
  ],
  "extension": [
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Gluteus Maximus"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "206007"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Hamstrings (Group)"
        },
        {
          "url": "role",
          "valueCode": "secondary"
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Erector Spinae Group"
        },
        {
          "url": "role",
          "valueCode": "stabilizer"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "44947003"
          }
        }
      ]
    },
    {
      "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": "Gluteus Medius"
        },
        {
          "url": "role",
          "valueCode": "stabilizer"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "78333006"
          }
        }
      ]
    }
  ]
}