{
  "resourceType": "ActivityDefinition",
  "id": "cervicothoracic-self-mobilization",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/cervicothoracic-self-mobilization",
  "version": "1",
  "name": "CervicothoracicSelfMobilization",
  "title": "Cervicothoracic Self-Mobilization",
  "status": "draft",
  "experimental": true,
  "description": "Combined cervical and thoracic spine mobility exercises using foam roller or towel roll. Patient performs supine thoracic extension over a roll positioned at the cervicothoracic junction, combined with active cervical range of motion. Demonstrates superior outcomes for pain reduction and ROM compared to cervical exercises alone.",
  "useContext": [
    {
      "code": {
        "system": "http://terminology.hl7.org/CodeSystem/usage-context-type",
        "code": "user"
      },
      "valueCodeableConcept": {
        "text": "difficulty: intermediate"
      }
    }
  ],
  "topic": [
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "cervicothoracic-self-mobilization",
          "display": "Cervicothoracic Self-Mobilization"
        }
      ]
    }
  ],
  "bodySite": [
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "thoracic-spine",
          "display": "Thoracic Spine"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "5261000",
          "display": "Structure of thoracic intervertebral disc"
        }
      ],
      "text": "Thoracic Spine"
    },
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "cervical-spine",
          "display": "Cervical Spine"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "68818006",
          "display": "Structure of cervical intervertebral disc"
        }
      ],
      "text": "Cervical Spine"
    }
  ],
  "kind": "ServiceRequest",
  "dosage": [
    {
      "text": "5-10 reps per segment, daily"
    }
  ],
  "usage": "Evidence: moderate.",
  "note": [
    {
      "text": "Long neck, soft jaw, breathe into the upper back",
      "authorString": "focus:internal"
    },
    {
      "text": "Drape your chest open over the roller",
      "authorString": "focus:external"
    },
    {
      "text": "Lift the sternum toward the ceiling between breaths",
      "authorString": "focus:external"
    },
    {
      "text": "Imagine the roller drawing a line up your spine",
      "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": "sun-cervicothoracic-2024",
      "citation": "Sun X, Chai L, Huang Q, Zhou H, Liu H. (2024). Effects of Exercise Combined With Cervicothoracic Spine Self-Mobilization on Chronic Non-Specific Neck Pain",
      "document": {
        "url": "https://doi.org/10.1038/s41598-024-55181-8"
      }
    },
    {
      "type": "citation",
      "label": "cho-thoracic-vs-cervical-2017",
      "citation": "Cho J, Lee E, Lee S. (2017). Upper Thoracic Spine Mobilization and Mobility Exercise Versus Upper Cervical Spine Mobilization and Stabilization Exercise in Individuals With Forward Head Posture: A Randomized Clinical Trial",
      "document": {
        "url": "https://doi.org/10.1186/s12891-017-1889-2"
      }
    }
  ],
  "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": "Deep Cervical Flexors"
        },
        {
          "url": "role",
          "valueCode": "stabilizer"
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Middle Trapezius"
        },
        {
          "url": "role",
          "valueCode": "secondary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "31764008"
          }
        }
      ]
    }
  ]
}