{
  "resourceType": "ActivityDefinition",
  "id": "isometric-neck-strengthening",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/isometric-neck-strengthening",
  "version": "1",
  "name": "IsometricNeckStrengthening",
  "title": "Isometric Neck Strengthening (4 Directions)",
  "status": "draft",
  "experimental": true,
  "description": "Manual resistance or hand-resisted cervical flexion, extension, lateral flexion, and rotation without movement. Thera-Band resistance produces 3.8-15.7% MVIC flexion and 20.2-34.8% MVIC extension. Programs >20 reps/session and >8 weeks duration show significant pain and disability improvements.",
  "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": "isometric-neck-strengthening",
          "display": "Isometric Neck Strengthening (4 Directions)"
        }
      ]
    }
  ],
  "bodySite": [
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "cervical-spine",
          "display": "Cervical Spine"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "68818006",
          "display": "Structure of cervical intervertebral disc"
        }
      ],
      "text": "Cervical Spine"
    }
  ],
  "kind": "ServiceRequest",
  "dosage": [
    {
      "text": "3×10 reps each direction with 5-10 second holds, >20 reps/session, >8 weeks duration [Yang 2022]"
    }
  ],
  "usage": "Evidence: strong. Thera-Band: flexion 3.8-15.7% MVIC, extension 20.2-34.8% MVIC. Cybex: flexion 20.9-83.5%, extension 40.6-95.8% [Burnett 2008]",
  "note": [
    {
      "text": "Long neck, jaw soft — match force without moving",
      "authorString": "focus:internal"
    },
    {
      "text": "Press your forehead into your palm; the palm doesn't move",
      "authorString": "focus:external"
    },
    {
      "text": "Resist a steady push from each side, front, and back",
      "authorString": "focus:external"
    },
    {
      "text": "Self-palpate upper traps — they should stay 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"
      }
    }
  ],
  "extension": [
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Deep Cervical Flexors"
        },
        {
          "url": "role",
          "valueCode": "primary"
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Sternocleidomastoid"
        },
        {
          "url": "role",
          "valueCode": "secondary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "22823000"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Erector Spinae Group"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "44947003"
          }
        }
      ]
    },
    {
      "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"
          }
        }
      ]
    }
  ]
}