{
  "resourceType": "ActivityDefinition",
  "id": "empty-can-exercise",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/empty-can-exercise",
  "version": "1",
  "name": "EmptyCanExercise",
  "title": "Empty Can Exercise (Scaption with Thumbs Down)",
  "status": "draft",
  "experimental": true,
  "description": "Shoulder elevation in the scapular plane with thumbs down (internal rotation). Classic supraspinatus test position but does NOT selectively isolate supraspinatus — 9 other shoulder muscles are equally activated. The internally rotated position narrows subacromial space. Full can has largely replaced this for rehabilitation, though it may be useful for middle deltoid recruitment.",
  "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": "empty-can-exercise",
          "display": "Empty Can Exercise (Scaption with Thumbs Down)"
        }
      ]
    }
  ],
  "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": "3×15 reps; use primarily as assessment, not primary rehabilitation exercise [Reinold 2008, Boettcher 2009]"
    }
  ],
  "usage": "Evidence: moderate. Middle deltoid 77±44% MVIC, posterior deltoid 54±24% MVIC. Smallest supraspinatus-to-deltoid ratio (0.8). Does not selectively activate supraspinatus [Boettcher 2009]",
  "note": [
    {
      "text": "Long neck, soft shrug — pinky leads the lift",
      "authorString": "focus:internal"
    },
    {
      "text": "Pour water from a can toward the floor",
      "authorString": "focus:external"
    },
    {
      "text": "Stop the lift at shoulder height — go no higher",
      "authorString": "focus:external"
    },
    {
      "text": "Free hand on upper trap to keep it quiet",
      "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": "reinold-supraspinatus-deltoid-2008",
      "citation": "Reinold MM, Macrina LC, Wilk KE, et al.. (2008). EMG Analysis of Supraspinatus and Deltoid During 3 Rehabilitation Exercises",
      "document": {
        "url": "https://doi.org/10.1016/s0162-0908(08)79368-1"
      }
    },
    {
      "type": "citation",
      "label": "boettcher-empty-full-can-2009",
      "citation": "Boettcher CE, Ginn KA, Cathers I. (2009). Empty Can and Full Can Tests Do Not Selectively Activate Supraspinatus",
      "document": {
        "url": "https://doi.org/10.1016/j.jsams.2008.09.005"
      }
    },
    {
      "type": "citation",
      "label": "thigpen-scapular-kinematics-2006",
      "citation": "Thigpen CA, Padua DA, Morgan N, Kreps C, Karas SG. (2006). Scapular Kinematics During Supraspinatus Exercises: Full Can vs Empty Can",
      "document": {
        "url": "https://doi.org/10.4085/1062-6050-50.9.06"
      }
    },
    {
      "type": "citation",
      "label": "escamilla-shoulder-rehab-2009",
      "citation": "Escamilla RF, Yamashiro K, Paulos L, Andrews JR. (2009). Shoulder Muscle Activity and Function in Common Shoulder Rehabilitation Exercises",
      "document": {
        "url": "https://doi.org/10.2165/00007256-200939080-00004"
      }
    },
    {
      "type": "predecessor",
      "label": "Switch to the thumbs-up full-can when the internally-rotated empty-can position provokes impingement; same scaption pattern with less impingement demand (listed as empty-can's own regression).",
      "display": "Full Can Exercise (Scaption with Thumbs Up)",
      "resource": "ActivityDefinition/full-can-exercise"
    }
  ],
  "extension": [
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Supraspinatus"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "6423006"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Middle 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": "Posterior Deltoid"
        },
        {
          "url": "role",
          "valueCode": "secondary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "35259002"
          }
        }
      ]
    }
  ]
}