{
  "resourceType": "ActivityDefinition",
  "id": "scapular-shrugs-depression",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/scapular-shrugs-depression",
  "version": "1",
  "name": "ScapularShrugsDepression",
  "title": "Scapular Elevation and Depression (Shrugs / Reverse Shrugs)",
  "status": "draft",
  "experimental": true,
  "description": "Shrugs for upper trapezius and levator scapulae; reverse shrugs for lower trapezius and serratus anterior. Shrugs at 90° or 150° ABD activate upward rotators and decrease downward rotation. UT 21-36% MVIC, levator scapulae 25-58% MVIC, LT 15-30% MVIC.",
  "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-shrugs-depression",
          "display": "Scapular Elevation and Depression (Shrugs / Reverse Shrugs)"
        }
      ]
    }
  ],
  "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 each direction (elevation + depression), 2-3x/week [Kibler 2008, Choi 2015]"
    }
  ],
  "usage": "Evidence: moderate. UT 21-36% MVIC. Levator scapulae 25-58% MVIC (robbery exercise highest). LT 15-30% MVIC depression [Berckmans 2021, Kibler 2008]",
  "note": [
    {
      "text": "Tall, long neck — shoulder blade glides up, then down",
      "authorString": "focus:internal"
    },
    {
      "text": "Lift the shoulders toward the earlobes, then drive them toward the back pockets",
      "authorString": "focus:external"
    },
    {
      "text": "Press both hands down toward the floor for the reverse shrug",
      "authorString": "focus:external"
    },
    {
      "text": "Pause at top and bottom — feel the trap fully shorten and lengthen",
      "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": "Upper 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": "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": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "31764008"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Serratus Anterior"
        },
        {
          "url": "role",
          "valueCode": "secondary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "18346003"
          }
        }
      ]
    }
  ]
}