{
  "resourceType": "ActivityDefinition",
  "id": "external-rotation-0-abduction",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/external-rotation-0-abduction",
  "version": "1",
  "name": "ExternalRotation0Abduction",
  "title": "External Rotation at 0° Abduction (Side-Lying or Band)",
  "status": "draft",
  "experimental": true,
  "description": "Rotator cuff strengthening targeting infraspinatus through external rotation with the arm at the side. Side-lying or standing with resistance band. Prevents superior humeral head migration and reduces impingement risk. Foundational for shoulder stability, progressible with resistance bands.",
  "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": "external-rotation-0-abduction",
          "display": "External Rotation at 0° Abduction (Side-Lying or Band)"
        }
      ]
    }
  ],
  "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": "3×8 at 8-RM, 3 days/week; 2-second eccentric"
    }
  ],
  "usage": "Evidence: strong. Infraspinatus 62% MVIC, teres minor 67% MVIC, supraspinatus 24-37% [Reinold 2004]",
  "note": [
    {
      "text": "Quiet shoulder, tall trunk — rotation starts at the back of the cuff",
      "authorString": "focus:internal"
    },
    {
      "text": "Pull the band toward the doorway behind you",
      "authorString": "focus:external"
    },
    {
      "text": "Rotate the wrist to point away from the body",
      "authorString": "focus:external"
    },
    {
      "text": "Towel under the elbow stays trapped throughout",
      "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": "mulroy-shoulder-sci-2020",
      "citation": "Mulroy SJ, Hafdahl L, Dyson-Hudson T. (2020). A Primary Care Provider's Guide to Shoulder Pain After Spinal Cord Injury",
      "document": {
        "url": "https://doi.org/10.46292/sci2603-186"
      }
    },
    {
      "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": "citation",
      "label": "reinold-rotator-cuff-emg-2004",
      "citation": "Reinold MM, Wilk KE, Fleisig GS, et al.. (2004). Electromyographic Analysis of the Rotator Cuff and Deltoid Musculature During Common Shoulder External Rotation Exercises",
      "document": {
        "url": "https://doi.org/10.2519/jospt.2004.34.7.385"
      }
    },
    {
      "type": "citation",
      "label": "hopewell-grasp-2021",
      "citation": "Hopewell S, Keene DJ, Marian IR, et al.. (2021). Progressive Exercise Compared With Best Practice Advice, With or Without Corticosteroid Injection, for the Treatment of Patients With Rotator Cuff Disorders (GRASP)",
      "document": {
        "url": "https://doi.org/10.7326/ACPJ202112210-137"
      }
    }
  ],
  "extension": [
    {
      "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": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "51159009"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Posterior Deltoid"
        },
        {
          "url": "role",
          "valueCode": "synergist"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "35259002"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Supraspinatus"
        },
        {
          "url": "role",
          "valueCode": "stabilizer"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "6423006"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Subscapularis"
        },
        {
          "url": "role",
          "valueCode": "lengthening"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "90588001"
          }
        }
      ]
    }
  ]
}