{
  "resourceType": "ActivityDefinition",
  "id": "cross-body-shoulder-stretch",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/cross-body-shoulder-stretch",
  "version": "1",
  "name": "CrossBodyShoulderStretch",
  "title": "Cross-Body Shoulder Stretch (Horizontal Adduction)",
  "status": "draft",
  "experimental": true,
  "description": "Standing or seated, pulling arm across body. Reduces GIRD by 14.77° and pain by 1.54 points — equivalent to sleeper stretch. Modified version increased IR ROM by 89.52% in tennis players. Reduces inferior posterior capsule shear modulus only (vs sleeper which affects both middle and inferior).",
  "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": "cross-body-shoulder-stretch",
          "display": "Cross-Body Shoulder Stretch (Horizontal Adduction)"
        }
      ]
    }
  ],
  "bodySite": [
    {
      "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": "3-5 reps of 30 seconds per side, daily for 4 weeks [de Araújo 2026]"
    }
  ],
  "usage": "Evidence: strong. GIRD reduction 14.77° (95% CI -19.70 to -9.84). Modified version: 89.52% IR ROM increase in tennis players [D 2023]",
  "note": [
    {
      "text": "Long, tall spine — back of shoulder lengthens",
      "authorString": "focus:internal"
    },
    {
      "text": "Pull the elbow toward the opposite shoulder",
      "authorString": "focus:external"
    },
    {
      "text": "Reach the fingertips toward the far wall",
      "authorString": "focus:external"
    },
    {
      "text": "Keep the working shoulder pinned away from the ear",
      "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": "Posterior Deltoid"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "35259002"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Infraspinatus"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "72573008"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Teres Minor"
        },
        {
          "url": "role",
          "valueCode": "secondary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "51159009"
          }
        }
      ]
    }
  ]
}