1.  Describe the metabolic and environmental factors that contribute to musculoskeletal tissue degeneration and impaired healing, including insulin resistance, chronic inflammation, sleep disruption, and psychosocial stress.  

2,  Explain how these metabolic and environmental drivers influence common PM&R conditions such as osteoarthritis, tendinopathy, chronic low back pain, and poor post-procedural recovery.  

3. Apply a simple clinical framework to identify modifiable metabolic and environmental contributors in patients with chronic musculoskeletal disorders in order to improve rehabilitation outcomes.