{
  "resourceType": "ActivityDefinition",
  "id": "modified-curl-up-dead-bug",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/modified-curl-up-dead-bug",
  "version": "1",
  "name": "ModifiedCurlUpDeadBug",
  "title": "Modified Curl-Up / Dead Bug",
  "status": "draft",
  "experimental": true,
  "description": "Two complementary anterior core exercises. Modified curl-up: supine with one knee bent, hands under lumbar spine, lift head and shoulders minimally. Dead bug: supine with arms and legs at 90°, lower opposite arm and leg while maintaining lumbar contact. Effectively activate rectus abdominis (50% nEMG) and external obliques while minimizing lumbar compression. Safe and well-tolerated in patients with low back pain.",
  "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": "modified-curl-up-dead-bug",
          "display": "Modified Curl-Up / Dead Bug"
        }
      ]
    }
  ],
  "bodySite": [
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "lumbar-spine",
          "display": "Lumbar Spine"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "23526008",
          "display": "Structure of lumbar intervertebral disc"
        }
      ],
      "text": "Lumbar Spine"
    },
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "thoracic-spine",
          "display": "Thoracic Spine"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "5261000",
          "display": "Structure of thoracic intervertebral disc"
        }
      ],
      "text": "Thoracic Spine"
    }
  ],
  "kind": "ServiceRequest",
  "dosage": [
    {
      "text": "3×8-12 reps; 5 graded intensity levels available"
    }
  ],
  "usage": "Evidence: strong. Rectus abdominis 48-50% nEMG during curl-up [Calatayud 2019]. Dead bug: peak RA and EO increase significantly with intensity [Kim 2016]",
  "note": [
    {
      "text": "Quiet ribs, anchored low back — deep core controls the limbs",
      "authorString": "focus:internal"
    },
    {
      "text": "Reach the opposite hand and heel toward opposite walls",
      "authorString": "focus:external"
    },
    {
      "text": "Press the lower back into the floor the entire time",
      "authorString": "focus:external"
    },
    {
      "text": "Hand under the lumbar spine feels constant gentle pressure",
      "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": "calatayud-core-tolerability-2019",
      "citation": "Calatayud J, Escriche-Escuder A, Cruz-Montecinos C, et al.. (2019). Tolerability and Muscle Activity of Core Muscle Exercises in Chronic Low-Back Pain",
      "document": {
        "url": "https://doi.org/10.3390/ijerph16193509"
      }
    },
    {
      "type": "citation",
      "label": "kim-lumbar-stabilization-emg-2016",
      "citation": "Kim CR, Park DK, Lee ST, Ryu JS. (2016). Electromyographic Changes in Trunk Muscles During Graded Lumbar Stabilization Exercises",
      "document": {
        "url": "https://doi.org/10.1016/j.pmrj.2016.05.017"
      }
    },
    {
      "type": "citation",
      "label": "juker-psoas-curl-up-1998",
      "citation": "Juker D, McGill S, Kropf P, Steffen T. (1998). Quantitative Intramuscular Myoelectric Activity of Lumbar Portions of Psoas and the Abdominal Wall",
      "document": {
        "url": "https://doi.org/10.1097/00005768-199802000-00020"
      }
    },
    {
      "type": "citation",
      "label": "beales-slr-motor-control-2009",
      "citation": "Beales DJ, O'Sullivan PB, Briffa NK. (2009). Motor Control Patterns During an Active Straight Leg Raise in Pain-Free Subjects",
      "document": {
        "url": "https://doi.org/10.1016/j.jelekin.2009.05.003"
      }
    },
    {
      "type": "citation",
      "label": "marcolin-pushup-variants-2015",
      "citation": "Marcolin G, Petrone N, Moro T, et al.. (2015). Selective Activation of Shoulder, Trunk, and Arm Muscles: A Comparative Analysis of Different Push-Up Variants",
      "document": {
        "url": "https://doi.org/10.4085/1062-6050-50.9.09"
      }
    }
  ],
  "extension": [
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Rectus Abdominis"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "31243008"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "External Oblique"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "1179024003"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Transversus Abdominis"
        },
        {
          "url": "role",
          "valueCode": "stabilizer"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "86493009"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Internal Oblique"
        },
        {
          "url": "role",
          "valueCode": "synergist"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "1179024003"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Iliopsoas"
        },
        {
          "url": "role",
          "valueCode": "stabilizer"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "68455001"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Multifidus"
        },
        {
          "url": "role",
          "valueCode": "stabilizer"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "5709001"
          }
        }
      ]
    }
  ]
}