{ "resourceType": "ActivityDefinition", "id": "push-up-plus", "url": "https://bodyiq.dev/fhir/ActivityDefinition/push-up-plus", "version": "1", "name": "PushUpPlus", "title": "Push-Up Plus", "status": "draft", "experimental": true, "description": "Standard push-up with an additional scapular protraction at the top (the 'plus'). Activates serratus anterior at high amplitude and lower trapezius over upper trapezius. Ideal for scapular stabilization. Addresses scapular winging and promotes upward rotation essential for overhead activities.", "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": "push-up-plus", "display": "Push-Up Plus" } ] } ], "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" }, { "coding": [ { "system": "https://bodyiq.dev/fhir/CodeSystem/exercise", "code": "elbow", "display": "Elbow" }, { "system": "http://snomed.info/sct", "code": "44034005", "display": "Structure of humeroulnar joint" } ], "text": "Elbow" } ], "kind": "ServiceRequest", "dosage": [ { "text": "3×8 at 8-RM, 3 days/week" } ], "usage": "Evidence: strong. High serratus anterior activation with favorable LT/UT ratio [Andersen 2012, Kibler 2008]", "note": [ { "text": "Wide shoulder blades at the top — serratus wraps the ribs", "authorString": "focus:internal" }, { "text": "Push the floor away until the upper back rounds", "authorString": "focus:external" }, { "text": "Drive the chest as far from the floor as possible", "authorString": "focus:external" }, { "text": "Body stays straight as a plank from crown to heel", "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": "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": "kibler-scapular-rehab-2008", "citation": "Kibler WB, Sciascia AD, Uhl TL, Tambay N, Cunningham T. (2008). Electromyographic Analysis of Specific Exercises for Scapular Control in Early Phases of Shoulder Rehabilitation", "document": { "url": "https://doi.org/10.1177/0363546508316281" } }, { "type": "citation", "label": "escamilla-shoulder-rehab-2009", "citation": "Escamilla RF, Yamashiro K, Paulos L, Andrews JR. (2009). Shoulder Muscle Activity and Function in Common Shoulder Rehabilitation Exercises", "document": { "url": "https://doi.org/10.2165/00007256-200939080-00004" } }, { "type": "citation", "label": "park-pushup-plus-serratus-2014", "citation": "Park KM, Cynn HS, Kwon OY, et al.. (2014). Comparison of Pectoralis Major and Serratus Anterior Muscle Activities During Different Push-Up Plus Exercises", "document": { "url": "https://doi.org/10.1519/JSC.0000000000000443" } }, { "type": "citation", "label": "kang-pushup-plus-meta-2019", "citation": "Kang FJ, Ou HL, Lin KY, Lin JJ. (2019). Serratus Anterior and Upper Trapezius EMG Analysis of the Push-Up Plus Exercise: A Systematic Review and Meta-Analysis", "document": { "url": "https://doi.org/10.4085/1062-6050-237-18" } }, { "type": "citation", "label": "herrington-press-up-progressions-2015", "citation": "Herrington L, Waterman R, Smith L. (2015). EMG Analysis of Shoulder Muscles During Press-Up Variations and Progressions", "document": { "url": "https://doi.org/10.1016/j.jelekin.2014.10.002" } }, { "type": "predecessor", "label": "Regress to the wall push-up (retaining the plus) to reduce body-weight load while preserving scapular protraction (listed as push-up-plus regression).", "display": "Wall Push-Up", "resource": "ActivityDefinition/wall-push-up" } ], "extension": [ { "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement", "extension": [ { "url": "muscle", "valueString": "Serratus Anterior" }, { "url": "role", "valueCode": "primary" }, { "url": "coding", "valueCoding": { "system": "http://snomed.info/sct", "code": "18346003" } } ] }, { "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": "Pectoralis Major" }, { "url": "role", "valueCode": "secondary" }, { "url": "coding", "valueCoding": { "system": "http://snomed.info/sct", "code": "60005003" } } ] }, { "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement", "extension": [ { "url": "muscle", "valueString": "Triceps Brachii" }, { "url": "role", "valueCode": "secondary" }, { "url": "coding", "valueCoding": { "system": "http://snomed.info/sct", "code": "40284004" } } ] }, { "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement", "extension": [ { "url": "muscle", "valueString": "Anterior Deltoid" }, { "url": "role", "valueCode": "synergist" }, { "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": "lengthening" }, { "url": "coding", "valueCoding": { "system": "http://snomed.info/sct", "code": "88530003" } } ] }, { "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement", "extension": [ { "url": "muscle", "valueString": "Middle Trapezius" }, { "url": "role", "valueCode": "lengthening" }, { "url": "coding", "valueCoding": { "system": "http://snomed.info/sct", "code": "31764008" } } ] }, { "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement", "extension": [ { "url": "muscle", "valueString": "Biceps Brachii" }, { "url": "role", "valueCode": "lengthening" }, { "url": "coding", "valueCoding": { "system": "http://snomed.info/sct", "code": "16225001" } } ] }, { "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement", "extension": [ { "url": "muscle", "valueString": "Brachialis" }, { "url": "role", "valueCode": "lengthening" }, { "url": "coding", "valueCoding": { "system": "http://snomed.info/sct", "code": "75915005" } } ] }, { "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement", "extension": [ { "url": "muscle", "valueString": "Brachioradialis" }, { "url": "role", "valueCode": "lengthening" }, { "url": "coding", "valueCoding": { "system": "http://snomed.info/sct", "code": "72111005" } } ] } ] }