{
  "resourceType": "ActivityDefinition",
  "id": "spanish-squat",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/spanish-squat",
  "version": "1",
  "name": "SpanishSquat",
  "title": "Spanish Squat (Belt-Assisted)",
  "status": "draft",
  "experimental": true,
  "description": "Squat performed with a belt or strap around the knees anchored to a fixed point, allowing posterior lean to reduce patellofemoral load. Limits knee flexion to 0-60° range where PF forces are lowest. VMO:VL ratios approach 1:1 in closed kinetic chain. APTA guidelines recommend high-volume protocols (3×30+ reps) as most effective for patellofemoral pain.",
  "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": "spanish-squat",
          "display": "Spanish Squat (Belt-Assisted)"
        }
      ]
    }
  ],
  "bodySite": [
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "knee",
          "display": "Knee"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "129159008",
          "display": "Structure of femorotibial joint"
        }
      ],
      "text": "Knee"
    },
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "hip",
          "display": "Hip"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "24136001",
          "display": "Structure of hip joint"
        }
      ],
      "text": "Hip"
    }
  ],
  "kind": "ServiceRequest",
  "dosage": [
    {
      "text": "3×15-30 reps, 0-60° knee flexion, 3-5 days/week for 6-12 weeks [APTA 2020, Neal 2024]"
    }
  ],
  "usage": "Evidence: limited. No specific Spanish squat EMG data. General CKC squats: VMO:VL approaching 1:1 [Chen 2018]. PF forces reduced 14.4% with decreased knee flexion [Kernozek 2020]",
  "note": [
    {
      "text": "Tall trunk, vertical shin — quads take the load posteriorly",
      "authorString": "focus:internal"
    },
    {
      "text": "Sit back into the strap as if into an invisible chair",
      "authorString": "focus:external"
    },
    {
      "text": "Push the floor away to return to standing",
      "authorString": "focus:external"
    },
    {
      "text": "Imagine sitting on a tall stool that vanishes at 60°",
      "authorString": "focus:imagery"
    }
  ],
  "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": "song-pf-loading-exercises-2023",
      "citation": "Song CY, Lin YF, Wei TC, Lin DH, Jan MH. (2023). PF Joint Loading Across 35 Exercises and ADLs",
      "document": {
        "url": "https://doi.org/10.1177/03635465231175160"
      }
    },
    {
      "type": "citation",
      "label": "kernozek-pf-visual-feedback-2020",
      "citation": "Kernozek TW, Gheidi N, Zellmer M, Hove J, Heinert BL. (2020). Visual Feedback Reduces PF Forces During Squatting",
      "document": {
        "url": "https://doi.org/10.1016/j.clinbiomech.2020.105050"
      }
    },
    {
      "type": "citation",
      "label": "chen-pfp-emg-2018",
      "citation": "Chen HY, Chien CC, Wu SK, Liau JJ, Jan MH. (2018). EMG of Hip and Knee Muscles in PFP: Observational Study",
      "document": {
        "url": "https://doi.org/10.1016/j.physio.2015.03.1305"
      }
    },
    {
      "type": "citation",
      "label": "neal-pfp-best-practice-2024",
      "citation": "Neal BS, Barton CJ, Gallie R, O'Halloran P, Morrissey D. (2024). Best Practice Guide for PFP",
      "document": {
        "url": "https://doi.org/10.1680/cbpg.36505"
      }
    }
  ],
  "extension": [
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Quadriceps Femoris"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "21989003"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Gluteus Maximus"
        },
        {
          "url": "role",
          "valueCode": "secondary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "206007"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Hamstrings (Group)"
        },
        {
          "url": "role",
          "valueCode": "stabilizer"
        }
      ]
    }
  ]
}