{
  "resourceType": "ActivityDefinition",
  "id": "thoracic-extension-rotation-mobilization",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/thoracic-extension-rotation-mobilization",
  "version": "1",
  "name": "ThoracicExtensionRotationMobilization",
  "title": "Thoracic Extension/Rotation Mobilization",
  "status": "draft",
  "experimental": true,
  "description": "Active mobility exercises targeting thoracic spine extension and rotation. Includes open book rotations in sidelying, quadruped thoracic rotation, and seated rotation with overpressure. Significantly improves thoracic kyphosis angle, cervical extension, and pain. More effective than cervical-only interventions for forward head posture.",
  "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": "thoracic-extension-rotation-mobilization",
          "display": "Thoracic Extension/Rotation Mobilization"
        }
      ]
    }
  ],
  "bodySite": [
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "thoracic-spine",
          "display": "Thoracic Spine"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "5261000",
          "display": "Structure of thoracic intervertebral disc"
        }
      ],
      "text": "Thoracic Spine"
    }
  ],
  "kind": "ServiceRequest",
  "dosage": [
    {
      "text": "3×10 reps each direction, daily"
    }
  ],
  "usage": "Evidence: moderate.",
  "note": [
    {
      "text": "Quiet hips — rotation lives in the mid-back",
      "authorString": "focus:internal"
    },
    {
      "text": "Open the top hand toward the wall behind you",
      "authorString": "focus:external"
    },
    {
      "text": "Eyes follow the hand across the ceiling",
      "authorString": "focus:external"
    },
    {
      "text": "Knees stacked — pelvis is the anchor",
      "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": "cho-thoracic-vs-cervical-2017",
      "citation": "Cho J, Lee E, Lee S. (2017). Upper Thoracic Spine Mobilization and Mobility Exercise Versus Upper Cervical Spine Mobilization and Stabilization Exercise in Individuals With Forward Head Posture: A Randomized Clinical Trial",
      "document": {
        "url": "https://doi.org/10.1186/s12891-017-1889-2"
      }
    },
    {
      "type": "citation",
      "label": "feng-kyphosis-correction-2018",
      "citation": "Feng Q, Wang M, Zhang Y, Zhou Y. (2018). The Effect of a Corrective Functional Exercise Program on Postural Thoracic Kyphosis in Teenagers: A Randomized Controlled Trial",
      "document": {
        "url": "https://doi.org/10.1177/0269215517714591"
      }
    }
  ],
  "extension": [
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Erector Spinae Group"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "44947003"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Multifidus"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "5709001"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Internal Oblique"
        },
        {
          "url": "role",
          "valueCode": "secondary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "1179024003"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "External Oblique"
        },
        {
          "url": "role",
          "valueCode": "secondary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "1179024003"
          }
        }
      ]
    }
  ]
}