{
  "resourceType": "ActivityDefinition",
  "id": "pendulum-exercise",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/pendulum-exercise",
  "version": "1",
  "name": "PendulumExercise",
  "title": "Pendulum Exercise (Codman's)",
  "status": "draft",
  "experimental": true,
  "description": "Leaning forward with the affected arm hanging, creating small circular or pendulum motions using body sway rather than active shoulder muscle contraction. Used in early-stage frozen shoulder (freezing phase) when active motion is too painful. Proposed mechanisms include joint distraction, synovial fluid circulation, and pain gate modulation.",
  "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": "pendulum-exercise",
          "display": "Pendulum Exercise (Codman's)"
        }
      ]
    }
  ],
  "bodySite": [
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "shoulder",
          "display": "Shoulder"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "85537004",
          "display": "Structure of glenohumeral joint"
        }
      ],
      "text": "Shoulder"
    }
  ],
  "kind": "ServiceRequest",
  "dosage": [
    {
      "text": "5-10 minutes, 2-3x daily; small circles in both directions, forward/back, and side-to-side. With or without 1-2 lb weight [expert consensus]"
    }
  ],
  "usage": "Evidence: limited.",
  "note": [
    {
      "text": "Heavy, relaxed arm — shoulder muscles do nothing",
      "authorString": "focus:internal"
    },
    {
      "text": "Sway the trunk like a slow metronome",
      "authorString": "focus:external"
    },
    {
      "text": "Let the hand trace a coffee-cup-sized circle on the floor",
      "authorString": "focus:external"
    },
    {
      "text": "The arm is a rope hanging from your shoulder",
      "authorString": "focus:imagery"
    }
  ],
  "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": "successor",
      "label": "Advance from passive pendulum to active-assisted wall finger-climbing once active motion is tolerable (listed as pendulum progression).",
      "display": "Wall Walks (Wall Finger Climbing)",
      "resource": "ActivityDefinition/wall-walks-shoulder"
    }
  ],
  "extension": [
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Supraspinatus"
        },
        {
          "url": "role",
          "valueCode": "stabilizer"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "6423006"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Anterior Deltoid"
        },
        {
          "url": "role",
          "valueCode": "stabilizer"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "35259002"
          }
        }
      ]
    }
  ]
}