{
  "resourceType": "ActivityDefinition",
  "id": "deep-neck-flexor-training",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/deep-neck-flexor-training",
  "version": "1",
  "name": "DeepNeckFlexorTraining",
  "title": "Deep Neck Flexor Training (Chin Tucks with Pressure Biofeedback)",
  "status": "draft",
  "experimental": true,
  "description": "Craniocervical flexion exercise targeting the deep cervical flexors (longus colli, longus capitis). Patient lies supine with a pressure biofeedback unit behind the neck and performs graded chin tuck contractions (22-30 mmHg). Improves neck pain, posture, and muscle endurance while increasing deep flexor cross-sectional area.",
  "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": "deep-neck-flexor-training",
          "display": "Deep Neck Flexor Training (Chin Tucks with Pressure Biofeedback)"
        }
      ]
    }
  ],
  "bodySite": [
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "cervical-spine",
          "display": "Cervical Spine"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "20292002",
          "display": "Structure of atlantooccipital joint"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "68818006",
          "display": "Structure of cervical intervertebral disc"
        }
      ],
      "text": "Cervical Spine"
    }
  ],
  "kind": "ServiceRequest",
  "dosage": [
    {
      "text": "10 reps × 10-second holds at each pressure level (22-30 mmHg), 2x daily for 6 weeks minimum"
    }
  ],
  "usage": "Evidence: strong. Linear EMG-pressure relationship (22-30 mmHg); longus colli 17.4% CSA increase at C2-C3 [Falla 2003, Cagnie 2010]",
  "note": [
    {
      "text": "Soft chin nod — back of neck quietly lengthens",
      "authorString": "focus:internal"
    },
    {
      "text": "Float the gauge needle from 22 toward 30 mmHg",
      "authorString": "focus:external"
    },
    {
      "text": "Hold the gauge steady for 10 seconds, then release",
      "authorString": "focus:external"
    },
    {
      "text": "Palpate the front of your neck — it stays soft",
      "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": "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": "gross-neck-exercises-2015",
      "citation": "Gross A, Kay TM, Paquin JP, et al.. (2015). Exercises for Mechanical Neck Disorders",
      "document": {
        "url": "https://doi.org/10.1002/14651858.CD004250.pub5"
      }
    },
    {
      "type": "citation",
      "label": "amiri-arimi-deep-flexors-2017",
      "citation": "Amiri Arimi S, Mohseni Bandpei MA, Javanshir K, Rezasoltani A, Biglarian A. (2017). The Effect of Different Exercise Programs on Size and Function of Deep Cervical Flexor Muscles in Patients With Chronic Nonspecific Neck Pain: A Systematic Review of Randomized Controlled Trials",
      "document": {
        "url": "https://doi.org/10.1097/phm.0000000000000721"
      }
    },
    {
      "type": "citation",
      "label": "moon-cervical-muscle-2021",
      "citation": "Moon H, Lee SK, Kim WM, Seo YG. (2021). Effects of Exercise on Cervical Muscle Strength and Cross-Sectional Area in Patients With Thoracic Hyperkyphosis and Chronic Cervical Pain",
      "document": {
        "url": "https://doi.org/10.1038/s41598-021-83344-4"
      }
    },
    {
      "type": "successor",
      "label": "Once the patient holds 30 mmHg CCF with minimal SCM activity, adding anti-gravity head liftoff is harder; DNF's named 'Chin Tuck with Head Lift' progression IS the supine-chin-tuck-liftoff node. Distinct roster nodes.",
      "display": "Supine Chin Tuck with Liftoff",
      "resource": "ActivityDefinition/supine-chin-tuck-liftoff"
    }
  ],
  "extension": [
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Deep Cervical Flexors"
        },
        {
          "url": "role",
          "valueCode": "primary"
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Sternocleidomastoid"
        },
        {
          "url": "role",
          "valueCode": "stabilizer"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "22823000"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Semispinalis Capitis"
        },
        {
          "url": "role",
          "valueCode": "lengthening"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "2666009"
          }
        }
      ]
    }
  ]
}