{
  "resourceType": "ActivityDefinition",
  "id": "wrist-extensor-stretch",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/wrist-extensor-stretch",
  "version": "1",
  "name": "WristExtensorStretch",
  "title": "Wrist Extensor Stretch",
  "status": "draft",
  "experimental": true,
  "description": "Stretch for the forearm extensor group. Extend the elbow and use the other hand to gently flex the wrist.",
  "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": "wrist-extensor-stretch",
          "display": "Wrist Extensor Stretch"
        }
      ]
    }
  ],
  "bodySite": [
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "wrist",
          "display": "Wrist"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "74670003",
          "display": "Structure of radiocarpal joint"
        }
      ],
      "text": "Wrist"
    }
  ],
  "kind": "ServiceRequest",
  "dosage": [
    {
      "text": "3×30-45 seconds per side, before and after eccentric exercises"
    }
  ],
  "usage": "Evidence: moderate.",
  "note": [
    {
      "text": "Long, straight elbow — extensor mass lengthens",
      "authorString": "focus:internal"
    },
    {
      "text": "Press the back of the hand toward the floor",
      "authorString": "focus:external"
    },
    {
      "text": "Stop where the stretch turns into a sharp edge",
      "authorString": "focus:external"
    },
    {
      "text": "Free hand sets the wrist position and holds it steady",
      "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": "hoogvliet-epicondylitis-2013",
      "citation": "Hoogvliet P, Randsdorp MS, Dingemanse R, Koes BW, Huisstede BM. (2013). Exercise Therapy and Mobilisation for Lateral and Medial Epicondylitis",
      "document": {
        "url": "https://doi.org/10.1136/bjsports-2012-091990"
      }
    },
    {
      "type": "citation",
      "label": "stasinopoulos-lateral-elbow-2005",
      "citation": "Stasinopoulos D, Stasinopoulou K, Johnson MI. (2005). Exercise Programme for Lateral Elbow Tendinopathy",
      "document": {
        "url": "https://doi.org/10.1136/bjsm.2005.019836"
      }
    },
    {
      "type": "citation",
      "label": "coombes-lateral-epicondylalgia-2013",
      "citation": "Coombes BK, Bisset L, Brooks P, Khan A, Vicenzino B. (2013). Corticosteroid Injection, Physiotherapy, or Both for Lateral Epicondylalgia",
      "document": {
        "url": "https://doi.org/10.1016/j.sjpain.2013.05.001"
      }
    },
    {
      "type": "citation",
      "label": "mcqueen-lateral-elbow-strengthening-2020",
      "citation": "McQueen KS, Powell RK, Keener T, Whalley R, Calfee RP. (2020). Role of Strengthening in Nonoperative Lateral Epicondyle Tendinopathy",
      "document": {
        "url": "https://doi.org/10.1016/j.jht.2020.10.009"
      }
    },
    {
      "type": "successor",
      "label": "The extensor stretch's 'Resisted Wrist Extension Eccentric' progression describes eccentric wrist extension; the Tyler Twist node is exactly eccentric wrist extension (FlexBar), a genuinely harder loaded variant.",
      "display": "Tyler Twist — Eccentric Wrist Extension (FlexBar)",
      "resource": "ActivityDefinition/tyler-twist-eccentric-wrist"
    }
  ],
  "extension": [
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Extensor Carpi Radialis Longus"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "39421004"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Extensor Digitorum"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "50176000"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Extensor Carpi Radialis Brevis"
        },
        {
          "url": "role",
          "valueCode": "lengthening"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "86172000"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Extensor Carpi Ulnaris"
        },
        {
          "url": "role",
          "valueCode": "lengthening"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "113227003"
          }
        }
      ]
    }
  ]
}