The roles of real-world shoulder biomechanics in rotator cuff tendinopathy rehabilitation
openNIAMS - National Institute of Arthritis and Musculoskeletal and Skin Diseases
PROJECT SUMMARY
Rotator cuff tendinopathy is a prevalent chronic disease that is painful, debilitating, and reduces the quality of
life. Physical therapy (PT) is an effective first-line treatment, but the non-response rate to PT is still high. Long-
term recovery is further limited, and the reason for pain recurrence is poorly explained. It is possible that the in-
clinic gains of PT fail to translate to good real-world mechanics and are overwhelmed by the pathomechanical
shoulder movements in activities of daily living. Clinical and basic science both suggest shoulder overuse and
motion-driven pathomechanics are causal factors of rotator cuff pathology. These biomechanical mechanisms
are unconfirmed in patients partly due to the complex interplays among pathology, mechanics, and treatment,
in addition to a paucity of methods to quantify the highly variable real-world motion and in-vivo tendon loading.
My overall goal is to discover how real-world shoulder biomechanics interact with the clinical outcomes of PT in
rotator cuff tendinopathy. This research progresses from a cross-sectional [K99] to a longitudinal cohort study
[R00]. My cross-sectional Aim 1 [K99] will use 1) wearable sensors to track 7-day bilateral shoulder cumulative
motion in daily living; 2) motion analysis and musculosketeal models to identify motion-driven pathomechanics
specific to daily living functional tasks; and 3) machine learning to combine sensor-detected activities with
motion-driven biomechanics to quantify real-world cumulative rotator cuff tendon loading. My mentored K99 will
validate research tools and define how patient shoulder motion and tendon loading deviate from normal status.
The longitudinal Aim 2 [R00] will link the real-world biomechanics established in Aim 1 with changes in clinical
outcomes, including pain, shoulder function, and tendon structure, through a 3-month PT protocol followed by
the first 6 months after PT completion. These Aims will clarify the mechanical mechanisms on how real-world
shoulder motion and loading alter the course of PT clinical outcomes in rotator cuff tendinopathy. Findings will
inform data-driven continuous rehabilitation paradigms that monitor and modify daily living activities to maintain
long-term shoulder health. This research will also serve as the foundation of Dr. Ke Song's career development
plan to acquire 2 years of mentored training [K99] and prepare for transition into independence [R00]. Through
the guidance of his experienced and interdisciplinary mentoring team, Dr. Song will perform hands-on training
with field-leading experts in shoulder biomechanics, physical therapy, orthopaedics, wearable sensors, data
science, and biostatistics to maximize the impact of his proposed research. Dr. Song will also learn from formal
courses and professional training activities to ensure his career progress, develop clinical research proficiency,
improve grant writing, mentoring, and leadership skills, and secure an independent tenure-track faculty position
at a clinical research-intensive institution. The scientific training, professional development, and research plans
will guide Dr. Song through a pathway to independent research in translational musculoskeletal biomechanics
that help patients with rotator cuff tendinopathy and related shoulder diseases improve long-term outcomes.
Up to $100K
health research