{
  "resourceType": "ActivityDefinition",
  "id": "core-stabilization-adim",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/core-stabilization-adim",
  "version": "1",
  "name": "CoreStabilizationAdim",
  "title": "Core Stabilization with Abdominal Drawing-In Maneuver (ADIM)",
  "status": "draft",
  "experimental": true,
  "description": "Core stabilization exercise targeting deep trunk muscles (transversus abdominis, multifidus). Patient draws the navel toward the spine without moving the pelvis, then maintains the contraction during limb movements. Reduces lumbar segmental translation and pain more effectively than general strengthening. Fundamental for lumbar instability and chronic low back pain.",
  "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": "core-stabilization-adim",
          "display": "Core Stabilization with Abdominal Drawing-In Maneuver (ADIM)"
        }
      ]
    }
  ],
  "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"
    }
  ],
  "kind": "ServiceRequest",
  "dosage": [
    {
      "text": "8-10 reps every 2 hours initially; 30 min 3x/week, 4 weeks minimum"
    }
  ],
  "usage": "Evidence: strong. Reduces sagittal translation at L4-L5/L5-S1 at 10 weeks [Puntumetakul 2021]. Bracing IAP 116.4 mmHg vs hollowing 9.9 mmHg [Tayashiki 2016]",
  "note": [
    {
      "text": "Soft, quiet belly — deep abdominal hollows toward the spine",
      "authorString": "focus:internal"
    },
    {
      "text": "Zip up a tight pair of jeans below the navel",
      "authorString": "focus:external"
    },
    {
      "text": "Hold the hollow while breathing into the lower ribs",
      "authorString": "focus:external"
    },
    {
      "text": "Fingertips inside the hip bones feel a gentle tightening",
      "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": "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": "puntumetakul-core-adim-2021",
      "citation": "Puntumetakul R, Saiklang P, Tapanya W, et al.. (2021). The Effects of Core Stabilization Exercise With the Abdominal Drawing-in Maneuver Technique Versus General Strengthening Exercise on Lumbar Segmental Motion in Patients With Clinical Lumbar Instability: A Randomized Controlled Trial With 12-Month Follow-Up",
      "document": {
        "url": "https://doi.org/10.3390/ijerph18157811"
      }
    },
    {
      "type": "citation",
      "label": "guo-core-training-types-2025",
      "citation": "Guo XB, Lan Q, Ding J, Tang L, Yang M. (2025). Effects of Different Types of Core Training on Pain and Functional Status in Patients With Chronic Nonspecific Low Back Pain: A Systematic Review and Meta-Analysis",
      "document": {
        "url": "https://doi.org/10.3389/fphys.2025.1672010"
      }
    },
    {
      "type": "successor",
      "label": "Maintain ADIM/neutral spine during single-leg lifts without lumbar motion, then progress to the dead bug (ADIM plus alternating arm+leg loading); ADIM's leg-lift progression is labeled the 'dead bug foundation'. Both are distinct supine core-stabilization nodes.",
      "display": "Modified Curl-Up / Dead Bug",
      "resource": "ActivityDefinition/modified-curl-up-dead-bug"
    },
    {
      "type": "successor",
      "label": "Sustain ADIM in quadruped against gravity with a neutral spine (the 'ADIM in Quadruped' step is described as the 'foundation for bird dog progression'), then add contralateral arm/leg extension. Same stabilization continuum, distinct roster nodes.",
      "display": "Bird Dog Exercise",
      "resource": "ActivityDefinition/bird-dog"
    }
  ],
  "extension": [
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Transversus Abdominis"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "86493009"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Multifidus"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "5709001"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Internal Oblique"
        },
        {
          "url": "role",
          "valueCode": "synergist"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "1179024003"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Diaphragm"
        },
        {
          "url": "role",
          "valueCode": "stabilizer"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "5798000"
          }
        }
      ]
    }
  ]
}