{
  "resourceType": "ActivityDefinition",
  "id": "ninety-ninety-hip-stretch",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/ninety-ninety-hip-stretch",
  "version": "1",
  "name": "NinetyNinetyHipStretch",
  "title": "90/90 Hip Stretch (Shinbox)",
  "status": "draft",
  "experimental": true,
  "description": "Seated with both hips at 90° flexion and 90° rotation — front leg in external rotation, back leg in internal rotation. Targets hip capsule, gluteals, and deep rotators. Myofascial stretching improved hip rotation by up to 56% over 6 weeks. No evidence of fascicle lengthening from stretching — improvements come from decreased stiffness (g=0.37) and increased stretch tolerance (g=0.74).",
  "useContext": [
    {
      "code": {
        "system": "http://terminology.hl7.org/CodeSystem/usage-context-type",
        "code": "user"
      },
      "valueCodeableConcept": {
        "text": "difficulty: intermediate"
      }
    }
  ],
  "topic": [
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "ninety-ninety-hip-stretch",
          "display": "90/90 Hip Stretch (Shinbox)"
        }
      ]
    }
  ],
  "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"
    }
  ],
  "kind": "ServiceRequest",
  "dosage": [
    {
      "text": "2-4 reps of 30-60 seconds per side, 5-7 days/week, ≥5 minutes total weekly [Thomas 2018]"
    }
  ],
  "usage": "Evidence: moderate.",
  "note": [
    {
      "text": "Tall, long spine — rotation lives at the hip socket",
      "authorString": "focus:internal"
    },
    {
      "text": "Press both knees toward the floor without moving the trunk",
      "authorString": "focus:external"
    },
    {
      "text": "Reach the chest gently over the front shin",
      "authorString": "focus:external"
    },
    {
      "text": "Both sit-bones stay anchored to the floor",
      "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": "Piriformis"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "75699001"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Gluteus Maximus"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "206007"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Gluteus Medius"
        },
        {
          "url": "role",
          "valueCode": "secondary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "78333006"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Gluteus Minimus"
        },
        {
          "url": "role",
          "valueCode": "secondary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "75297007"
          }
        }
      ]
    }
  ]
}