{
  "resourceType": "ActivityDefinition",
  "id": "sleeper-stretch",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/sleeper-stretch",
  "version": "1",
  "name": "SleeperStretch",
  "title": "Sleeper Stretch (Posterior Shoulder)",
  "status": "draft",
  "experimental": true,
  "description": "Sidelying on target shoulder at 90° forward flexion, passively rotating forearm toward floor. Reduces GIRD by 14.69° and pain by 2.17 points over 4 weeks. Decreases posterior capsule shear modulus at both middle and inferior regions. Risk of suprascapular nerve compression with excessive force.",
  "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": "sleeper-stretch",
          "display": "Sleeper Stretch (Posterior Shoulder)"
        }
      ]
    }
  ],
  "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": "3-5 reps of 30 seconds, daily for 4-6 weeks [Maenhout 2012, Iida 2025]"
    }
  ],
  "usage": "Evidence: strong. IR improvement: 13.5° ± 0.8° over 6 weeks [Maenhout 2012]. Meta-analysis: IR ROM MD 7° (95% CI 1-13°) [Iida 2025]. Decreases infraspinatus stiffness [Yamauchi 2016]",
  "note": [
    {
      "text": "Quiet shoulder, packed scapula — stretch sits in the back of the joint",
      "authorString": "focus:internal"
    },
    {
      "text": "Press the forearm gently toward the floor",
      "authorString": "focus:external"
    },
    {
      "text": "Stop where the stretch turns into a sharp edge",
      "authorString": "focus:external"
    },
    {
      "text": "Bottom shoulder stays planted on the surface",
      "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": "predecessor",
      "label": "Use the lower-compression cross-body posterior-shoulder stretch if the sleeper provokes pinching (listed as sleeper regression); same GIRD target tissue.",
      "display": "Cross-Body Shoulder Stretch (Horizontal Adduction)",
      "resource": "ActivityDefinition/cross-body-shoulder-stretch"
    }
  ],
  "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"
          }
        }
      ]
    }
  ]
}