{
  "resourceType": "ActivityDefinition",
  "id": "full-can-exercise",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/full-can-exercise",
  "version": "1",
  "name": "FullCanExercise",
  "title": "Full Can Exercise (Scaption with Thumbs Up)",
  "status": "draft",
  "experimental": true,
  "description": "Standing shoulder elevation in the scapular plane (30-45° anterior to coronal plane) with thumbs up. Targets supraspinatus with superior supraspinatus-to-deltoid ratio compared to empty can. Reduces subacromial impingement risk by promoting scapular upward rotation and posterior tilt. Holmgren et al. found 69% successful outcomes vs 24% controls, with only 20% proceeding to surgery vs 63%.",
  "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": "full-can-exercise",
          "display": "Full Can Exercise (Scaption with Thumbs Up)"
        }
      ]
    }
  ],
  "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, 1-2x daily for 12 weeks; or progressive resistance 5 days/week over 12-16 weeks [Holmgren 2012, GRASP 2021]"
    }
  ],
  "usage": "Evidence: strong. Supraspinatus: similar to empty can; middle deltoid: 52±27% MVIC (vs 77±44% in empty can, p=0.001). Superior supraspinatus-to-deltoid ratio [Reinold 2008]",
  "note": [
    {
      "text": "Tall spine, thumbs up — long line through the arm",
      "authorString": "focus:internal"
    },
    {
      "text": "Pour water from a glass toward the ceiling",
      "authorString": "focus:external"
    },
    {
      "text": "Lift in the scapular plane, hand to shoulder height",
      "authorString": "focus:external"
    },
    {
      "text": "Free hand on upper trap — 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": "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": "kijkunasathian-supraspinatus-isolation-2023",
      "citation": "Kijkunasathian C, Limitlaohaphan C, Sanguanrungsirikul S, et al.. (2023). Preferable Shoulder Position to Isolate Supraspinatus",
      "document": {
        "url": "https://doi.org/10.1186/s12891-023-06372-3"
      }
    },
    {
      "type": "citation",
      "label": "holmgren-subacromial-exercise-2012",
      "citation": "Holmgren T, Björnsson Hallgren H, Öberg B, Adolfsson L, Johansson K. (2012). Specific Exercise Strategy on Need for Surgery in Subacromial Impingement",
      "document": {
        "url": "https://doi.org/10.1136/bmj.e787"
      }
    },
    {
      "type": "citation",
      "label": "dube-fitt-rotator-cuff-2024",
      "citation": "Dubé MO, Desmeules F, Lewis JS, Roy JS. (2024). FITT Odyssey: Exercise Programs for Rotator Cuff Shoulder Pain",
      "document": {
        "url": "https://doi.org/10.2519/jospt.2024.12452"
      }
    },
    {
      "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": "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": "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": "secondary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "35259002"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Upper Trapezius"
        },
        {
          "url": "role",
          "valueCode": "stabilizer"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "31764008"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Serratus Anterior"
        },
        {
          "url": "role",
          "valueCode": "stabilizer"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "18346003"
          }
        }
      ]
    }
  ]
}