{
  "resourceType": "ActivityDefinition",
  "id": "pelvic-tilt-realignment",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/pelvic-tilt-realignment",
  "version": "1",
  "name": "PelvicTiltRealignment",
  "title": "Pelvic Realignment Exercises (Pelvic Tilts)",
  "status": "draft",
  "experimental": true,
  "description": "Supine pelvic tilt exercises for lumbopelvic awareness and motor control. Patient alternates between anterior and posterior pelvic tilts, then practices holding neutral. Part of pericapsular soft tissue and realignment (PSTR) approach. Significantly improves pain (NRS) and function (Harris Hip Score) in hip OA. Enhances lumbopelvic awareness and reduces hypertonic guarding in 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": "pelvic-tilt-realignment",
          "display": "Pelvic Realignment Exercises (Pelvic Tilts)"
        }
      ]
    }
  ],
  "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"
    }
  ],
  "kind": "ServiceRequest",
  "dosage": [
    {
      "text": "3×10-15 reps each direction; find neutral and hold 10 seconds"
    }
  ],
  "usage": "Evidence: moderate.",
  "note": [
    {
      "text": "Slow, segmental rocking — pelvis rotates around the hip sockets",
      "authorString": "focus:internal"
    },
    {
      "text": "Flatten the lower back into the floor, then arch it away",
      "authorString": "focus:external"
    },
    {
      "text": "Find the middle position and hold it for three breaths",
      "authorString": "focus:external"
    },
    {
      "text": "Hand under the lower back feels pressure come and go",
      "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": "hayashi-pstr-hip-2022",
      "citation": "Hayashi K, Tsunoda T, Tobo Y, Ichikawa F, Shimose T. (2022). Effects of Pericapsular Soft Tissue and Realignment Exercises for Patients With Osteoarthritis of the Hip and Harris Hip Score Below 60 Points",
      "document": {
        "url": "https://doi.org/10.1080/03007995.2022.2088716"
      }
    },
    {
      "type": "citation",
      "label": "liu-lbp-exercise-2025",
      "citation": "Liu X, Gao W, Wu P, et al.. (2025). Effects of Different Exercise Interventions on Lower Back Pain: A Systematic Review and Meta-Analysis",
      "document": {
        "url": "https://doi.org/10.3389/fnhum.2025.1721182"
      }
    },
    {
      "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": "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"
      }
    }
  ],
  "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": "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": "Erector Spinae Group"
        },
        {
          "url": "role",
          "valueCode": "secondary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "44947003"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Iliopsoas"
        },
        {
          "url": "role",
          "valueCode": "secondary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "68455001"
          }
        }
      ]
    },
    {
      "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"
          }
        }
      ]
    }
  ]
}