{
  "resourceType": "ActivityDefinition",
  "id": "scapular-downward-rotation-control",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/scapular-downward-rotation-control",
  "version": "1",
  "name": "ScapularDownwardRotationControl",
  "title": "Scapular Downward Rotation Control (Arm Lowering)",
  "status": "draft",
  "experimental": true,
  "description": "Controlled arm lowering from overhead emphasizing eccentric scapular downward rotation. Rhomboid major 25-45% MVIC, levator scapulae 25-58% MVIC. Clinically relevant for hand-behind-back movements. Downward rotation is primarily addressed through controlled mobility rather than 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": "scapular-downward-rotation-control",
          "display": "Scapular Downward Rotation Control (Arm Lowering)"
        }
      ]
    }
  ],
  "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"
        }
      ],
      "text": "Shoulder"
    }
  ],
  "kind": "ServiceRequest",
  "dosage": [
    {
      "text": "3×10 reps slow arm lowering (3-5 second eccentric), 2-3x/week"
    }
  ],
  "usage": "Evidence: limited.",
  "note": [
    {
      "text": "Quiet shoulder, long spine — eccentric lives in rhomboids",
      "authorString": "focus:internal"
    },
    {
      "text": "Lower the hand along an arc to the back hip pocket",
      "authorString": "focus:external"
    },
    {
      "text": "Take 4 slow seconds to bring the arm down",
      "authorString": "focus:external"
    },
    {
      "text": "Free hand on the shoulder blade — feel it glide smoothly",
      "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"
      }
    }
  ],
  "extension": [
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Rhomboid Major"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "88530003"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Levator Scapulae"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "11327007"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Lower Trapezius"
        },
        {
          "url": "role",
          "valueCode": "stabilizer"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "31764008"
          }
        }
      ]
    }
  ]
}