{
  "resourceType": "ActivityDefinition",
  "id": "heel-raise",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/heel-raise",
  "version": "1",
  "name": "HeelRaise",
  "title": "Heel Raise (Calf Raise)",
  "status": "draft",
  "experimental": true,
  "description": "Standing plantarflexion exercise. Patient rises onto balls of feet, lifting heels off the ground.",
  "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": "heel-raise",
          "display": "Heel Raise (Calf Raise)"
        }
      ]
    }
  ],
  "bodySite": [
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "ankle",
          "display": "Ankle"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "70258002",
          "display": "Structure of ankle joint"
        }
      ],
      "text": "Ankle"
    }
  ],
  "kind": "ServiceRequest",
  "dosage": [
    {
      "text": "3×15-20 reps bilateral, progress to 3×10-15 single-leg"
    }
  ],
  "usage": "Evidence: moderate. Gastroc and soleus co-primary ~23% MVIC each; knee bent shifts to soleus dominant [Hébert-Losier 2012]",
  "note": [
    {
      "text": "Tall trunk, soft knees — calf drives the rise",
      "authorString": "focus:internal"
    },
    {
      "text": "Push the floor away to stand on the toes",
      "authorString": "focus:external"
    },
    {
      "text": "Reach the crown of the head toward the ceiling",
      "authorString": "focus:external"
    },
    {
      "text": "Weight stays under the big toe and second toe",
      "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": "wu-ankle-sprain-2025",
      "citation": "Wu V, Padilla CA, Smith NA. (2025). Management of Acute Ankle Sprains: Common Questions and Answers"
    },
    {
      "type": "citation",
      "label": "zeng-exercise-knee-oa-2022",
      "citation": "Zeng CY, Zhang ZR, Tang ZM, Hua FZ. (2022). Benefits and Mechanisms of Exercise Training for Knee Osteoarthritis",
      "document": {
        "url": "https://doi.org/10.3390/ijms232314953"
      }
    },
    {
      "type": "citation",
      "label": "hebert-losier-heel-raise-2012",
      "citation": "Hébert-Losier K, Schneiders AG, García JA, Sullivan SJ, Simoneau GG. (2012). Influence of Knee Flexion Angle and Age on Triceps Surae Muscle Activity During Heel Raises",
      "document": {
        "url": "https://doi.org/10.1519/JSC.0b013e31824435cf"
      }
    },
    {
      "type": "citation",
      "label": "hali-triceps-surae-motor-units-2019",
      "citation": "Hali K, Kirk EA, Rice CL. (2019). Effect of Knee Joint Position on Triceps Surae Motor Unit Recruitment and Firing Rates",
      "document": {
        "url": "https://doi.org/10.1007/s00221-019-05570-7"
      }
    },
    {
      "type": "successor",
      "label": "Tolerate 15+ bilateral concentric reps; add slow (4s) eccentric lowering off a step edge.",
      "display": "Heel Raise (Eccentric Emphasis)",
      "resource": "ActivityDefinition/heel-raise-eccentric"
    }
  ],
  "extension": [
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Gastrocnemius"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "35616000"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Soleus"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "78376008"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Tibialis Posterior"
        },
        {
          "url": "role",
          "valueCode": "synergist"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "74318005"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Peroneus Longus (Fibularis Longus)"
        },
        {
          "url": "role",
          "valueCode": "synergist"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "59831009"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Tibialis Anterior"
        },
        {
          "url": "role",
          "valueCode": "lengthening"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "73508007"
          }
        }
      ]
    }
  ]
}