{
  "resourceType": "ActivityDefinition",
  "id": "terminal-knee-extension",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/terminal-knee-extension",
  "version": "1",
  "name": "TerminalKneeExtension",
  "title": "Terminal Knee Extension (TKE)",
  "status": "draft",
  "experimental": true,
  "description": "Standing with resistance band behind knee. Extend the last 30° of knee extension against band resistance. Targets VMO and full knee extension.",
  "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": "terminal-knee-extension",
          "display": "Terminal Knee Extension (TKE)"
        }
      ]
    }
  ],
  "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"
    }
  ],
  "kind": "ServiceRequest",
  "dosage": [
    {
      "text": "3×15-20 reps; focus on last 15° of extension"
    }
  ],
  "usage": "Evidence: strong. VM and VL significantly more active during last 15° extension [Gryzlo 1994]",
  "note": [
    {
      "text": "Locked knee, quiet trunk — quad finishes the last 30°",
      "authorString": "focus:internal"
    },
    {
      "text": "Push the back of the knee into the band",
      "authorString": "focus:external"
    },
    {
      "text": "Reach the kneecap straight ahead at full extension",
      "authorString": "focus:external"
    },
    {
      "text": "Free hand on quad — feel it engage at lockout",
      "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": "va-hip-knee-oa-2020",
      "citation": "Matthew Bair MD MS, John Cody MD, Jess Edison MD, et al.. (2020). The Non-Surgical Management of Hip & Knee Osteoarthritis (OA) (2020)",
      "document": {
        "url": "https://doi.org/10.1016/j.ijotn.2020.100840"
      }
    },
    {
      "type": "citation",
      "label": "sharma-knee-oa-2021",
      "citation": "Sharma L. (2021). Osteoarthritis of the Knee",
      "document": {
        "url": "https://doi.org/10.1007/s40883-021-00226-x"
      }
    },
    {
      "type": "citation",
      "label": "gryzlo-knee-rehab-emg-1994",
      "citation": "Gryzlo SM, Patek RM, Pink M, Perry J. (1994). Electromyographic Analysis of Knee Rehabilitation Exercises",
      "document": {
        "url": "https://doi.org/10.2519/jospt.1994.20.1.36"
      }
    },
    {
      "type": "citation",
      "label": "escamilla-cruciate-loading-2012",
      "citation": "Escamilla RF, Macleod TD, Wilk KE, Paulos L, Andrews JR. (2012). Cruciate Ligament Loading During Common Knee Rehabilitation Exercises",
      "document": {
        "url": "https://doi.org/10.1177/0954411912451839"
      }
    }
  ],
  "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"
          }
        }
      ]
    }
  ]
}