{
  "resourceType": "ActivityDefinition",
  "id": "hip-flexor-hamstring-stretch",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/hip-flexor-hamstring-stretch",
  "version": "1",
  "name": "HipFlexorHamstringStretch",
  "title": "Hip Flexor and Hamstring Stretching",
  "status": "draft",
  "experimental": true,
  "description": "Flexibility exercises addressing hip ROM impairments. Half-kneeling hip flexor stretch (iliopsoas, rectus femoris) and supine hamstring stretch. Improves function in hip OA and addresses limited hip mobility that affects lumbar spine mechanics.",
  "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": "hip-flexor-hamstring-stretch",
          "display": "Hip Flexor and Hamstring Stretching"
        }
      ]
    }
  ],
  "bodySite": [
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "hip",
          "display": "Hip"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "24136001",
          "display": "Structure of hip joint"
        }
      ],
      "text": "Hip"
    },
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "knee",
          "display": "Knee"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "129159008",
          "display": "Structure of femorotibial joint"
        }
      ],
      "text": "Knee"
    }
  ],
  "kind": "ServiceRequest",
  "dosage": [
    {
      "text": "3×30-60 seconds per side, daily; 10-30 seconds general, 30-60 for older adults"
    }
  ],
  "usage": "Evidence: moderate. Single session hip flexor stretch: 1.2° APT reduction but no lumbar lordosis change [Preece 2021]. Dynamic stretching ES 3.01-3.06 for hip ROM [Iranmanesh 2025]",
  "note": [
    {
      "text": "Posterior pelvic tilt first — front of hip lengthens",
      "authorString": "focus:internal"
    },
    {
      "text": "Drive the front knee toward the wall ahead",
      "authorString": "focus:external"
    },
    {
      "text": "For hamstring, reach the heel toward the ceiling with the strap",
      "authorString": "focus:external"
    },
    {
      "text": "Tailbone tucks under like closing a wallet",
      "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": "cibulka-hip-oa-cpg-2017",
      "citation": "Cibulka MT, Bloom NJ, Enseki KR, et al.. (2017). Hip Pain and Mobility Deficits-Hip Osteoarthritis: Revision 2017",
      "document": {
        "url": "https://doi.org/10.2519/jospt.2017.0301"
      }
    },
    {
      "type": "citation",
      "label": "moreside-hip-rom-2012",
      "citation": "Moreside JM, McGill SM. (2012). Hip Joint Range of Motion Improvements Using Three Different Interventions",
      "document": {
        "url": "https://doi.org/10.1519/JSC.0b013e31824f2351"
      }
    },
    {
      "type": "citation",
      "label": "plandowska-hamstring-stretch-lbp-2024",
      "citation": "Plandowska M, Labecka MK, Truszczyńska-Baszak A, Rajabi R, Płaszewski M. (2024). Active Hamstring Stretching and Core Control for LBP During Prolonged Sitting",
      "document": {
        "url": "https://doi.org/10.3390/jcm13175048"
      }
    },
    {
      "type": "citation",
      "label": "iranmanesh-hip-flexor-stretch-lbp-2025",
      "citation": "Iranmanesh M, Shafiei Nikou S, Saadatian A, et al.. (2025). Dynamic Stretching of Hip Flexors on Hip ROM and Pain in Football Players With LBP",
      "document": {
        "url": "https://doi.org/10.1519/00126548-199906000-00021"
      }
    },
    {
      "type": "citation",
      "label": "preece-hip-flexor-pelvic-tilt-2021",
      "citation": "Preece SJ, Tan YF, Alghamdi TDA, Arnall FA. (2021). Pelvic Tilt Before and After Hip Flexor Stretching",
      "document": {
        "url": "https://doi.org/10.1016/j.jmpt.2020.09.006"
      }
    },
    {
      "type": "citation",
      "label": "garber-acsm-exercise-quantity-2011",
      "citation": "Garber CE, Blissmer B, Deschenes MR, et al.. (2011). ACSM Position Stand: Quantity and Quality of Exercise",
      "document": {
        "url": "https://doi.org/10.1249/MSS.0b013e318213fefb"
      }
    },
    {
      "type": "successor",
      "label": "Progress the standard half-kneeling stretch to the rear-foot-elevated couch position to add knee-flexion RF stretch.",
      "display": "Couch Stretch (Rectus Femoris / Hip Flexor)",
      "resource": "ActivityDefinition/couch-stretch"
    }
  ],
  "extension": [
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Iliopsoas"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "68455001"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Rectus Femoris"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "72226001"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Hamstrings (Group)"
        },
        {
          "url": "role",
          "valueCode": "primary"
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Biceps Femoris — Long Head"
        },
        {
          "url": "role",
          "valueCode": "lengthening"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "55190004"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Semitendinosus"
        },
        {
          "url": "role",
          "valueCode": "lengthening"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "50340007"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Semimembranosus"
        },
        {
          "url": "role",
          "valueCode": "lengthening"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "84010001"
          }
        }
      ]
    }
  ]
}