{
  "resourceType": "ActivityDefinition",
  "id": "scapular-retraction-exercise",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/scapular-retraction-exercise",
  "version": "1",
  "name": "ScapularRetractionExercise",
  "title": "Scapular Retraction Exercise",
  "status": "draft",
  "experimental": true,
  "description": "Squeeze shoulder blades together in a seated or standing position. Foundational exercise for scapular stability and posture.",
  "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-retraction-exercise",
          "display": "Scapular Retraction Exercise"
        }
      ]
    }
  ],
  "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": "3×10-15 reps with 5-second holds"
    }
  ],
  "usage": "Evidence: moderate.",
  "note": [
    {
      "text": "Long neck, soft trap — middle of the back does the work",
      "authorString": "focus:internal"
    },
    {
      "text": "Pinch a pencil between the shoulder blades",
      "authorString": "focus:external"
    },
    {
      "text": "Pull the back of the shirt against the chair",
      "authorString": "focus:external"
    },
    {
      "text": "Free hand on upper trap to keep it quiet",
      "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": "cho-thoracic-vs-cervical-2017",
      "citation": "Cho J, Lee E, Lee S. (2017). Upper Thoracic Spine Mobilization and Mobility Exercise Versus Upper Cervical Spine Mobilization and Stabilization Exercise in Individuals With Forward Head Posture: A Randomized Clinical Trial",
      "document": {
        "url": "https://doi.org/10.1186/s12891-017-1889-2"
      }
    },
    {
      "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": "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"
      }
    },
    {
      "type": "citation",
      "label": "johnson-trapezius-anatomy-1994",
      "citation": "Johnson G, Bogduk N, Nowitzke A, House D. (1994). Anatomy and Actions of the Trapezius Muscle",
      "document": {
        "url": "https://doi.org/10.1016/0268-0033(94)90057-4"
      }
    },
    {
      "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"
      }
    },
    {
      "type": "citation",
      "label": "williams-unstable-overhead-2020",
      "citation": "Williams MR, Hendricks DS, Dannen MJ, Arnold AM, Lawrence MA. (2020). Activity of Shoulder Stabilizers and Prime Movers During an Unstable Overhead Press",
      "document": {
        "url": "https://doi.org/10.1519/JSC.0000000000002660"
      }
    },
    {
      "type": "successor",
      "label": "Progress isolated retraction to the gravity-loaded prone Y adding scapular upward rotation (listed as retraction-exercise progression).",
      "display": "Prone Y-Raise",
      "resource": "ActivityDefinition/prone-y-raise"
    }
  ],
  "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": "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": "Serratus Anterior"
        },
        {
          "url": "role",
          "valueCode": "lengthening"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "18346003"
          }
        }
      ]
    },
    {
      "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"
          }
        }
      ]
    }
  ]
}