An Integrated Approach to Musculoskeletal Performance, Disease, and Recovery.

Optimizing rehabilitation outcomes, including preventing pathology and its progression, relies on a comprehensive knowledge of the condition's etiology. Put simply, we cannot optimally prevent or treat what we do not understand. Understanding the etiology of musculoskeletal syndromes and diseases is challenging because these conditions likely result from the interaction between multiple complex factors including time, underlying biology and physiology, and task demands on the system. Furthermore, behavioral and social determinants of health likely play important roles. Research seeking to understand the etiology of a musculoskeletal condition requires a robust and comprehensive conceptual framework that explicitly identifies key variables, relationships, and outcomes measures. The validity of this framework ultimately determines the utility and clinical impact of the research, and therefore deserves frequent and careful scrutiny. In this point of view, we will explore the predominant conceptual framework that has guided research into the etiology of rotator cuff pathology and propose a framework that can help guide future research in an effort to optimally prevent and treat rotator cuff pathology. Although this point of view explores the proposed framework within the context of rotator cuff pathology, it can be generalized and applied across musculoskeletal rehabilitation and research.