{
  "resourceType": "ActivityDefinition",
  "id": "shoulder-internal-rotation-exercise",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/shoulder-internal-rotation-exercise",
  "version": "1",
  "name": "ShoulderInternalRotationExercise",
  "title": "Resisted Internal Rotation",
  "status": "draft",
  "experimental": true,
  "description": "Side-lying or standing with band/cable. Rotate forearm inward against resistance while keeping elbow at side. Targets subscapularis and internal rotators.",
  "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": "shoulder-internal-rotation-exercise",
          "display": "Resisted Internal 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": "3×10-15 reps; progress through phases over 12-16 weeks"
    }
  ],
  "usage": "Evidence: moderate. Subscapularis 44-81.7% MVIC depending on position; belly press most specific [Ginn 2017]",
  "note": [
    {
      "text": "Tall trunk — IR comes from the front of the shoulder",
      "authorString": "focus:internal"
    },
    {
      "text": "Pull the band across the body toward the belly",
      "authorString": "focus:external"
    },
    {
      "text": "Rotate the wrist to point at the opposite hip",
      "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": "greis-subscapularis-liftoff-1996",
      "citation": "Greis PE, Kuhn JE, Schultheis J, Hintermeister R, Hawkins R. (1996). Validation of the Lift-Off Test and Analysis of Subscapularis Activity",
      "document": {
        "url": "https://doi.org/10.1177/036354659602400505"
      }
    },
    {
      "type": "citation",
      "label": "ginn-subscapularis-ir-2017",
      "citation": "Ginn KA, Reed D, Jones C, et al.. (2017). Is Subscapularis Recruited in a Similar Manner During Shoulder IR Exercises and Belly Press and Lift Off Tests?",
      "document": {
        "url": "https://doi.org/10.1016/j.jsams.2016.10.018"
      }
    },
    {
      "type": "citation",
      "label": "suenaga-ir-arm-positions-2003",
      "citation": "Suenaga N, Minami A, Fujisawa H. (2003). EMG Analysis of Internal Rotational Motion of the Shoulder in Various Arm Positions",
      "document": {
        "url": "https://doi.org/10.1016/s1058-2746(03)00169-1"
      }
    },
    {
      "type": "citation",
      "label": "pennock-bear-hug-positions-2011",
      "citation": "Pennock AT, Pennington WW, Torry MR, et al.. (2011). The Influence of Arm and Shoulder Position on the Bear-Hug, Belly-Press, and Lift-Off Tests",
      "document": {
        "url": "https://doi.org/10.1177/0363546510392710"
      }
    },
    {
      "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": "decker-subscapularis-rehab-2003",
      "citation": "Decker MJ, Tokish JM, Ellis HB, Torry MR, Hawkins RJ. (2003). Subscapularis Activity During Selected Rehabilitation Exercises",
      "document": {
        "url": "https://doi.org/10.1177/03635465030310010601"
      }
    },
    {
      "type": "citation",
      "label": "kelly-rotator-cuff-testing-1996",
      "citation": "Kelly BT, Kadrmas WR, Speer KP. (1996). Manual Muscle Examination for Rotator Cuff Strength",
      "document": {
        "url": "https://doi.org/10.1177/036354659602400504"
      }
    }
  ],
  "extension": [
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Subscapularis"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "90588001"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Pectoralis Major"
        },
        {
          "url": "role",
          "valueCode": "secondary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "60005003"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Latissimus Dorsi"
        },
        {
          "url": "role",
          "valueCode": "secondary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "15665001"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Anterior Deltoid"
        },
        {
          "url": "role",
          "valueCode": "stabilizer"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "35259002"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Teres Major"
        },
        {
          "url": "role",
          "valueCode": "secondary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "1193009"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Infraspinatus"
        },
        {
          "url": "role",
          "valueCode": "lengthening"
        },
        {
          "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": "lengthening"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "51159009"
          }
        }
      ]
    }
  ]
}