{
  "resourceType": "ActivityDefinition",
  "id": "quad-strengthening-slr-tke",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/quad-strengthening-slr-tke",
  "version": "1",
  "name": "QuadStrengtheningSlrTke",
  "title": "Quadriceps Strengthening (SLR / Terminal Knee Extension)",
  "status": "draft",
  "experimental": true,
  "description": "Foundational knee exercises combining straight leg raises and terminal knee extension. SLR: supine with knee locked, lift leg to 45°. TKE: standing with band behind knee, extend the last 30°. Both target quadriceps for OA management, improving pain, function, and joint stability through concentric and eccentric strengthening.",
  "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": "quad-strengthening-slr-tke",
          "display": "Quadriceps Strengthening (SLR / Terminal Knee Extension)"
        }
      ]
    }
  ],
  "bodySite": [
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "knee",
          "display": "Knee"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "129159008",
          "display": "Structure of femorotibial joint"
        }
      ],
      "text": "Knee"
    },
    {
      "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": "3×10-15 reps; moderate intensity 3x/week"
    }
  ],
  "usage": "Evidence: strong.",
  "note": [
    {
      "text": "Locked knee, quiet trunk — quad drives the lift",
      "authorString": "focus:internal"
    },
    {
      "text": "Lift the heel toward the ceiling on the SLR",
      "authorString": "focus:external"
    },
    {
      "text": "Push the back of the knee into the band on TKE",
      "authorString": "focus:external"
    },
    {
      "text": "Both sides of the pelvis stay equally pressed down",
      "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": "va-hip-knee-oa-2020",
      "citation": "Matthew Bair MD MS, John Cody MD, Jess Edison MD, et al.. (2020). The Non-Surgical Management of Hip & Knee Osteoarthritis (OA) (2020)",
      "document": {
        "url": "https://doi.org/10.1016/j.ijotn.2020.100840"
      }
    },
    {
      "type": "citation",
      "label": "sharma-knee-oa-2021",
      "citation": "Sharma L. (2021). Osteoarthritis of the Knee",
      "document": {
        "url": "https://doi.org/10.1007/s40883-021-00226-x"
      }
    },
    {
      "type": "citation",
      "label": "zeng-exercise-knee-oa-2022",
      "citation": "Zeng CY, Zhang ZR, Tang ZM, Hua FZ. (2022). Benefits and Mechanisms of Exercise Training for Knee Osteoarthritis",
      "document": {
        "url": "https://doi.org/10.3390/ijms232314953"
      }
    },
    {
      "type": "citation",
      "label": "andersen-therapeutic-vs-heavy-2006",
      "citation": "Andersen LL, Magnusson SP, Nielsen M, et al.. (2006). Neuromuscular Activation in Conventional Therapeutic Exercises and Heavy Resistance Exercises: Implications for Rehabilitation",
      "document": {
        "url": "https://doi.org/10.1093/ptj/86.5.683"
      }
    },
    {
      "type": "citation",
      "label": "gryzlo-knee-rehab-emg-1994",
      "citation": "Gryzlo SM, Patek RM, Pink M, Perry J. (1994). Electromyographic Analysis of Knee Rehabilitation Exercises",
      "document": {
        "url": "https://doi.org/10.2519/jospt.1994.20.1.36"
      }
    },
    {
      "type": "citation",
      "label": "escamilla-cruciate-loading-2012",
      "citation": "Escamilla RF, Macleod TD, Wilk KE, Paulos L, Andrews JR. (2012). Cruciate Ligament Loading During Common Knee Rehabilitation Exercises",
      "document": {
        "url": "https://doi.org/10.1177/0954411912451839"
      }
    },
    {
      "type": "citation",
      "label": "lawford-cochrane-knee-oa-2024",
      "citation": "Lawford BJ, Hall M, Hinman RS, et al.. (2024). Exercise for Osteoarthritis of the Knee",
      "document": {
        "url": "https://doi.org/10.1071/HC24182"
      }
    },
    {
      "type": "successor",
      "label": "Progress from open-chain quad control to closed-chain eccentric quad loading once pain-free.",
      "display": "Eccentric Step-Down",
      "resource": "ActivityDefinition/eccentric-step-down"
    }
  ],
  "extension": [
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Quadriceps Femoris"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "21989003"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Rectus Femoris"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "72226001"
          }
        }
      ]
    },
    {
      "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": "Hamstrings (Group)"
        },
        {
          "url": "role",
          "valueCode": "lengthening"
        }
      ]
    }
  ]
}