{
  "resourceType": "ActivityDefinition",
  "id": "resisted-external-rotation",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/resisted-external-rotation",
  "version": "1",
  "name": "ResistedExternalRotation",
  "title": "Resisted External Rotation",
  "status": "draft",
  "experimental": true,
  "description": "Side-lying or standing with band/cable. Rotate forearm outward against resistance while keeping elbow at side. Key rotator cuff exercise.",
  "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": "resisted-external-rotation",
          "display": "Resisted External Rotation"
        }
      ]
    }
  ],
  "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": "3×8 at 8-RM, 3 days/week; 2-second eccentric"
    }
  ],
  "usage": "Evidence: strong. Infraspinatus 62% MVIC, teres minor 67% MVIC [Reinold 2004]",
  "note": [
    {
      "text": "Quiet shoulder — rotation starts at the back of the cuff",
      "authorString": "focus:internal"
    },
    {
      "text": "Pull the band away from the body's centerline",
      "authorString": "focus:external"
    },
    {
      "text": "Rotate the wrist to point at the far wall",
      "authorString": "focus:external"
    },
    {
      "text": "Towel under the elbow stays trapped throughout",
      "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": "mulroy-shoulder-sci-2020",
      "citation": "Mulroy SJ, Hafdahl L, Dyson-Hudson T. (2020). A Primary Care Provider's Guide to Shoulder Pain After Spinal Cord Injury",
      "document": {
        "url": "https://doi.org/10.46292/sci2603-186"
      }
    },
    {
      "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": "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": "lafrance-rotator-cuff-fitt-2024",
      "citation": "Lafrance S, Charron M, Dubé MO, et al.. (2024). The Efficacy of Exercise Therapy for Rotator Cuff-Related Shoulder Pain According to the FITT Principle: A Systematic Review With Meta-Analyses",
      "document": {
        "url": "https://doi.org/10.2519/jospt.2024.12453"
      }
    },
    {
      "type": "citation",
      "label": "hopewell-grasp-2021",
      "citation": "Hopewell S, Keene DJ, Marian IR, et al.. (2021). Progressive Exercise Compared With Best Practice Advice, With or Without Corticosteroid Injection, for the Treatment of Patients With Rotator Cuff Disorders (GRASP)",
      "document": {
        "url": "https://doi.org/10.7326/ACPJ202112210-137"
      }
    },
    {
      "type": "citation",
      "label": "gaudet-isokinetic-shoulder-2018",
      "citation": "Gaudet S, Tremblay J, Begon M. (2018). Muscle Recruitment Patterns of the Subscapularis, Serratus Anterior and Other Shoulder Girdle Muscles During Isokinetic IR and ER",
      "document": {
        "url": "https://doi.org/10.1080/02640414.2017.1347697"
      }
    },
    {
      "type": "citation",
      "label": "lang-shoulder-rotator-elevation-2021",
      "citation": "Lang AE, Lin JH, Dickerson CR. (2021). Activation Patterns of Shoulder Internal and External Rotators During Pure Axial Moment Generation",
      "document": {
        "url": "https://doi.org/10.1016/j.jbiomech.2021.110503"
      }
    },
    {
      "type": "citation",
      "label": "cools-rotator-cuff-exercises-2020",
      "citation": "Cools AM, Tongel AV, Berckmans K, et al.. (2020). EMG Analysis of Selected Shoulder Exercises for Patients With Symptomatic Degenerative Rotator Cuff Tears",
      "document": {
        "url": "https://doi.org/10.1016/j.jse.2020.03.019"
      }
    }
  ],
  "extension": [
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Infraspinatus"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "72573008"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Teres Minor"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "51159009"
          }
        }
      ]
    },
    {
      "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": "Subscapularis"
        },
        {
          "url": "role",
          "valueCode": "lengthening"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "90588001"
          }
        }
      ]
    }
  ]
}