{
  "resourceType": "ActivityDefinition",
  "id": "prone-horizontal-abduction-er",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/prone-horizontal-abduction-er",
  "version": "1",
  "name": "ProneHorizontalAbductionEr",
  "title": "Prone Horizontal Abduction with External Rotation (Prone Y/T)",
  "status": "draft",
  "experimental": true,
  "description": "Lying face down, lift arms in a Y or T position with thumbs pointing up (external rotation). Demonstrates optimal scapular neuromuscular control with excellent UT/MT ratio (0.43) and UT/LT ratio (0.30). Activates middle and lower trapezius at >50% MVIC while keeping upper trapezius <20%.",
  "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": "prone-horizontal-abduction-er",
          "display": "Prone Horizontal Abduction with External Rotation (Prone Y/T)"
        }
      ]
    }
  ],
  "bodySite": [
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "shoulder",
          "display": "Shoulder"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "264190008",
          "display": "Structure of scapulothoracic joint"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "85537004",
          "display": "Structure of glenohumeral joint"
        }
      ],
      "text": "Shoulder"
    }
  ],
  "kind": "ServiceRequest",
  "dosage": [
    {
      "text": "3×8-15 reps, 3 days/week"
    }
  ],
  "usage": "Evidence: strong. MT and LT >50% MVIC; optimal UT/MT ratio 0.43, UT/LT ratio 0.30 [Mendez-Rebolledo 2024]",
  "note": [
    {
      "text": "Long neck, lifted breastbone — pull from below the shoulder blade",
      "authorString": "focus:internal"
    },
    {
      "text": "Lift the thumbs toward the ceiling",
      "authorString": "focus:external"
    },
    {
      "text": "Reach the hands wide toward the far walls",
      "authorString": "focus:external"
    },
    {
      "text": "Pinch a coin between the lower shoulder blades",
      "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": "mendez-rebolledo-scapular-emg-2024",
      "citation": "Mendez-Rebolledo G, Araya-Quintanilla F, Guzmán-Muñoz E, et al.. (2024). Comparative Electromyographic Study of Scapular Stabilizing Muscles During Five Main Rehabilitation Exercises",
      "document": {
        "url": "https://doi.org/10.1097/PHM.0000000000002394"
      }
    },
    {
      "type": "citation",
      "label": "andersen-scapular-intensity-2012",
      "citation": "Andersen CH, Zebis MK, Saervoll C, et al.. (2012). Scapular Muscle Activity From Selected Strengthening Exercises Performed at Low and High Intensities",
      "document": {
        "url": "https://doi.org/10.1519/jsc.0b013e31823f8d24"
      }
    },
    {
      "type": "citation",
      "label": "reinold-rotator-cuff-emg-2004",
      "citation": "Reinold MM, Wilk KE, Fleisig GS, et al.. (2004). Electromyographic Analysis of the Rotator Cuff and Deltoid Musculature During Common Shoulder External Rotation Exercises",
      "document": {
        "url": "https://doi.org/10.2519/jospt.2004.34.7.385"
      }
    },
    {
      "type": "citation",
      "label": "berckmans-scapular-emg-2021",
      "citation": "Berckmans KR, Castelein B, Borms D, Parlevliet T, Cools A. (2021). Rehabilitation Exercises for Dysfunction of the Scapula: Exploration of Muscle Activity Using Fine-Wire EMG",
      "document": {
        "url": "https://doi.org/10.1177/03635465211025002"
      }
    }
  ],
  "extension": [
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Middle Trapezius"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "31764008"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Lower Trapezius"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "31764008"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Infraspinatus"
        },
        {
          "url": "role",
          "valueCode": "secondary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "72573008"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Posterior Deltoid"
        },
        {
          "url": "role",
          "valueCode": "secondary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "35259002"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Rhomboid Major"
        },
        {
          "url": "role",
          "valueCode": "synergist"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "88530003"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Pectoralis Major"
        },
        {
          "url": "role",
          "valueCode": "lengthening"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "60005003"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Anterior Deltoid"
        },
        {
          "url": "role",
          "valueCode": "lengthening"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "35259002"
          }
        }
      ]
    }
  ]
}