Lateral Knee Pain: Causes & Treatment

Lateral knee pain, a common ailment affecting individuals across various activity levels, often stems from issues within the lateral compartment of the knee. This area, crucial for stability and weight distribution, is bounded by anatomical structures such as the lateral collateral ligament (LCL), which provides support against varus stress. Conditions like iliotibial (IT) band syndrome, frequently diagnosed using clinical assessments and sometimes imaging techniques like magnetic resonance imaging (MRI), can contribute to pain on the outer side of the knee. Understanding the interplay of these elements is essential for effective diagnosis and treatment planning, potentially involving specialists in sports medicine for comprehensive care.

Lateral knee pain, characterized by discomfort on the outer side of the knee, is a prevalent musculoskeletal complaint affecting individuals across various activity levels and age groups. Recognizing the nuanced nature of this pain, its potential origins, and effective management strategies are paramount.

Defining Lateral Knee Pain

Lateral knee pain manifests through a spectrum of sensations, ranging from a dull ache to a sharp, stabbing pain. It can be localized to a specific point or radiate across the outer knee. Common symptoms include:

• Tenderness upon palpation of the lateral knee.
• Pain that intensifies with activities such as running, pivoting, or climbing stairs.
• A feeling of instability or giving way in the knee.
• Swelling or stiffness around the lateral aspect of the joint.

The Crucial Role of Anatomy in Diagnosis and Treatment

A thorough grasp of the intricate anatomy of the knee is indispensable for accurate diagnosis and targeted treatment of lateral knee pain. The knee is a complex joint composed of bones, ligaments, tendons, and cartilage, all working in concert to facilitate movement and bear weight.

Understanding how these structures interact and their individual vulnerabilities to injury is crucial in identifying the specific source of pain. Without this foundational knowledge, treatment can be misdirected, leading to prolonged discomfort and potentially hindering recovery.

Focus on the Lateral Compartment

The lateral compartment of the knee is the primary focus when addressing lateral knee pain. This compartment comprises the lateral meniscus, the lateral collateral ligament (LCL), the lateral femoral condyle, and the lateral tibial plateau. Each component plays a vital role in knee function:

• The lateral meniscus acts as a shock absorber and enhances joint stability.
• The LCL provides stability against excessive sideways movement.
• The femoral condyle and tibial plateau articulate to allow smooth motion.

Dysfunction or injury to any of these structures can precipitate lateral knee pain.

Activities That Exacerbate Lateral Knee Pain

Certain activities can significantly exacerbate lateral knee pain, placing undue stress on the lateral compartment. These include:

• High-impact activities: Running, jumping, and other plyometric exercises.
• Pivoting and twisting movements: Common in sports like soccer, basketball, and tennis.
• Prolonged sitting with knees bent: Can compress the lateral structures.
• Climbing stairs or hiking uphill: Increases stress on the knee joint.

Being mindful of these activities and implementing appropriate modifications can help alleviate pain and prevent further injury. Recognizing the specific activities that trigger or worsen lateral knee pain can assist in making informed choices about exercise and daily routines.

Anatomy of the Lateral Knee: A Closer Look

Lateral knee pain often stems from intricate interactions within the knee's anatomical structures. To understand the origins of this discomfort, a detailed exploration of the lateral knee compartment is essential. This compartment comprises several key components, including the lateral meniscus, lateral collateral ligament (LCL), femur, tibia, popliteus tendon, and biceps femoris tendon. Each plays a critical role in knee function and stability. Understanding their individual characteristics and collective functionality is critical to accurately diagnosing and treating lateral knee pain.

The Lateral Meniscus: Shock Absorption and Joint Stability

The lateral meniscus, a C-shaped fibrocartilaginous structure, resides between the femur and tibia on the lateral aspect of the knee.

Its composition consists of collagen fibers arranged in a specific pattern, providing tensile strength and resilience.

This unique structure serves as a crucial shock absorber, dissipating forces generated during weight-bearing activities.

By increasing the contact area between the femur and tibia, the meniscus also contributes significantly to joint stability, preventing excessive movement and reducing the risk of injury. The lateral meniscus further assists in joint lubrication and nutrition.

The Lateral Collateral Ligament (LCL): Varus Stability

The lateral collateral ligament (LCL) is a strong, cord-like structure that spans the lateral aspect of the knee joint.

It originates from the lateral epicondyle of the femur and inserts onto the head of the fibula.

The primary function of the LCL is to provide stability against varus stress, which is a force that pushes the knee outward. This is crucial for maintaining proper alignment and preventing excessive lateral movement.

The LCL works in conjunction with other ligaments and structures, such as the lateral capsule and popliteus tendon, to ensure comprehensive knee stability.

The Femur and Tibia: Bony Foundation

The femur and tibia, the major bones of the thigh and lower leg, respectively, form the bony foundation of the knee joint. Specifically, the lateral condyle of the femur articulates with the lateral plateau of the tibia.

This articulation is essential for weight-bearing and load transmission during various activities.

The shape and alignment of these bony surfaces influence knee biomechanics and stability.

The smooth articular cartilage covering the bony surfaces allows for frictionless movement. Damage or degeneration of this cartilage, as seen in osteoarthritis, can lead to pain and dysfunction.

The Popliteus Tendon: Unlocking and Meniscal Stabilization

The popliteus tendon, a small but important structure, originates from the lateral femoral condyle and inserts onto the posterior aspect of the tibia.

Its primary function is to initiate knee unlocking from full extension.

The popliteus tendon also plays a role in stabilizing the lateral meniscus during knee movement, preventing it from being trapped or injured.

Its complex interaction with the lateral meniscus and other structures contributes to the overall smooth functioning of the knee joint.

The Biceps Femoris Tendon: A Potential Pain Generator

The biceps femoris tendon, one of the hamstring tendons, attaches to the fibular head, which is located on the lateral aspect of the proximal lower leg.

Due to its proximity to the lateral knee joint, the biceps femoris tendon can potentially contribute to lateral knee pain.

Tightness or inflammation of this tendon can cause pain and discomfort in the lateral knee region.

Understanding its anatomical relationship to other structures is important for accurate diagnosis and treatment.

Integrated Function: A Symphony of Structures

The structures within the lateral knee compartment work together in a complex and coordinated manner to ensure proper knee function.

The meniscus provides shock absorption and stability, while the LCL resists varus stress. The femur and tibia provide the bony framework for weight-bearing, and the popliteus tendon initiates knee unlocking and stabilizes the meniscus. The biceps femoris tendon, while not directly within the joint, can influence lateral knee pain.

Any disruption to these structures can lead to lateral knee pain and dysfunction. A comprehensive understanding of the anatomy and biomechanics of the lateral knee is essential for healthcare professionals to accurately diagnose and treat lateral knee pain, restoring function, and improving patient outcomes.

Common Culprits: Causes of Lateral Knee Pain

Lateral knee pain often arises from specific pathologies that compromise the integrity and function of the knee's lateral compartment. Identifying the root cause is crucial for effective treatment. Several conditions commonly contribute to discomfort in this region, ranging from acute injuries to chronic degenerative processes. These include lateral meniscus tears, LCL sprains/tears, lateral knee osteoarthritis, iliotibial band syndrome (ITBS), and popliteus tendinitis/strain. A closer examination of each condition is essential.

Lateral Meniscus Tear

The lateral meniscus, a C-shaped cartilage in the knee, acts as a shock absorber and stabilizer. A tear in this structure can significantly impact knee function.

Mechanisms and Symptoms

Lateral meniscus tears typically occur through twisting injuries or direct impact to the knee. These injuries are common in athletes participating in sports with frequent pivoting or sudden stops. Symptoms of a lateral meniscus tear include:

• Pain, particularly along the lateral joint line.
• Clicking or popping sensations within the knee.
• Episodes of locking or catching, hindering full range of motion.

Diagnostic Considerations

Diagnosis often involves a physical examination, including specific tests like the McMurray test. MRI is the gold standard for confirming the presence and extent of the tear.

LCL Sprain/Tear

The Lateral Collateral Ligament (LCL) provides stability to the outer side of the knee, preventing excessive varus (outward) movement. Injuries to the LCL can compromise this stability.

Classification and Symptoms

LCL sprains/tears are classified into three grades based on severity:

• Grade I: Mild sprain with minimal ligament damage.
• Grade II: Partial tear with moderate instability.
• Grade III: Complete tear resulting in significant instability.

Associated symptoms include pain, swelling, and a feeling of instability in the knee, especially with lateral stress.

Instability Concerns

A complete LCL tear (Grade III) can lead to chronic instability, increasing the risk of further injury and potentially accelerating the development of osteoarthritis.

Lateral Knee Osteoarthritis

Osteoarthritis (OA) is a degenerative joint disease characterized by the breakdown of cartilage. When OA affects the lateral compartment of the knee, it can lead to significant pain and functional limitations.

Degenerative Changes and Risk Factors

The gradual loss of cartilage in the lateral compartment causes bones to rub together, resulting in pain, inflammation, and stiffness. Risk factors for lateral knee OA include:

• Age
• Obesity
• Previous knee injuries
• Genetic predisposition

Impact on Joint Function

OA impacts joint function by causing pain, stiffness, and reduced range of motion. Daily activities such as walking, climbing stairs, or even standing for long periods can become difficult and painful.

Iliotibial Band Syndrome (ITBS)

Iliotibial Band Syndrome (ITBS) is a common overuse injury that affects the iliotibial (IT) band, a thick band of tissue running along the outside of the thigh from the hip to the knee.

Mechanism and Symptoms

ITBS occurs when the IT band rubs against the lateral femoral epicondyle (the bony prominence on the outside of the knee), causing friction and inflammation. Symptoms typically include:

• Burning pain on the outside of the knee.
• Pain that worsens with activity, particularly running.
• A snapping sensation as the IT band moves over the epicondyle.

Predisposing Factors

Several factors can predispose individuals to ITBS, including:

• A tight IT band.
• Improper footwear.
• Running on uneven surfaces.
• Inadequate warm-up and stretching.

Popliteus Tendinitis/Strain

The popliteus muscle plays a crucial role in knee stability and unlocking the knee from a fully extended position. Inflammation or strain of the popliteus tendon can cause lateral knee pain.

Causes and Symptoms

Popliteus tendinitis/strain can result from:

• Overuse, especially in activities involving downhill running.
• Direct trauma to the back of the knee.

Symptoms include pain behind the knee, which is often exacerbated by downhill running or activities that require repetitive knee flexion.

Relationship to Knee Biomechanics

Proper knee biomechanics are essential to avoid overstressing the popliteus tendon. Factors such as poor foot alignment or muscle imbalances can contribute to the development of popliteus tendinitis/strain.

Less Common Causes

While the aforementioned conditions are the most frequent culprits behind lateral knee pain, less common causes should also be considered. These include:

• Peroneal nerve entrapment: Compression of the peroneal nerve as it passes around the fibular head can cause pain, numbness, and weakness in the lower leg and foot.
• Biceps Femoris Tendinopathy: Inflammation or degeneration of the biceps femoris tendon where it inserts onto the fibular head.

A thorough evaluation is critical to accurately diagnose the source of lateral knee pain and guide appropriate treatment strategies.

Diagnosis: Pinpointing the Source of Your Pain

Lateral knee pain often arises from specific pathologies that compromise the integrity and function of the knee's lateral compartment. Identifying the root cause is crucial for effective treatment. Several conditions commonly contribute to discomfort in this region, ranging from acute injuries to chronic degeneration.

Accurate diagnosis requires a multifaceted approach, combining a thorough physical examination with advanced imaging techniques. This meticulous process ensures that the correct pathology is identified, leading to a targeted and effective treatment plan.

The Crucial Role of Physical Examination

The physical examination is the cornerstone of diagnosing lateral knee pain. A skilled clinician can gather invaluable information through careful observation and palpation. This hands-on assessment often provides initial clues about the underlying problem.

Key Components of the Physical Exam

The physical examination consists of several key components. These include:

• Observation: The clinician observes the patient's posture, gait, and any visible signs of swelling or deformity.

• Palpation: Careful palpation of the lateral knee structures helps identify areas of tenderness or structural abnormalities.

• Range of Motion Assessment: Assessing the knee's range of motion can reveal limitations or pain with specific movements.

• Stability Testing: Stability testing, including the varus stress test, is crucial for evaluating the integrity of the lateral collateral ligament (LCL).

Specific Tests for Meniscus and Ligament Injuries

Specific clinical tests help assess the integrity of the lateral meniscus and ligaments. McMurray's test, for instance, is used to evaluate meniscal tears. Similarly, the Lachman test can provide insights into LCL integrity.

These tests, when performed correctly, can significantly narrow the differential diagnosis. They guide further investigations and treatment strategies.

The Power of MRI: Visualizing Soft Tissue Damage

Magnetic Resonance Imaging (MRI) is an indispensable tool for visualizing the soft tissue structures of the knee. This includes the meniscus, ligaments, and tendons. MRI excels at detecting subtle injuries that may not be apparent on physical examination alone.

Detecting Injuries and Ruling Out Other Conditions

MRI allows clinicians to visualize meniscal tears, ligament sprains, and tendinopathies with remarkable clarity. It is also effective in ruling out other potential causes of lateral knee pain, such as stress fractures or osteochondral lesions.

By providing detailed anatomical information, MRI significantly enhances diagnostic accuracy. This enables clinicians to tailor treatment plans to the specific pathology.

X-Ray: Assessing Bony Structures

While MRI is ideal for soft tissues, X-ray (radiography) remains valuable for assessing bony structures. X-rays are particularly useful for ruling out fractures and evaluating for signs of osteoarthritis.

Utility in Assessing Bone Structures

X-rays can reveal fractures, dislocations, and other bony abnormalities that may contribute to lateral knee pain. They can also help assess the severity of arthritis by visualizing joint space narrowing and bone spurs.

Although X-rays provide limited information about soft tissues, they are an essential component of the diagnostic workup. They offer crucial insights into the structural integrity of the knee joint.

Differential Diagnoses and Accurate Diagnosis

Lateral knee pain can stem from a variety of causes, necessitating a thorough differential diagnosis. Conditions like iliotibial (IT) band syndrome, biceps femoris tendinopathy, and peroneal nerve entrapment can mimic other pathologies. This can complicate the diagnostic process.

Accurate diagnosis is paramount because it dictates the course of treatment. A misdiagnosis can lead to ineffective or even harmful interventions. Therefore, clinicians must consider all possible causes of lateral knee pain. They should use a combination of physical examination findings and imaging results to arrive at the correct diagnosis.

Only through a precise and comprehensive diagnostic approach can we ensure that patients receive the most appropriate and effective treatment for their specific condition. This precision is key to restoring function and alleviating pain.

Treatment Options: From Conservative Care to Surgery

Lateral knee pain often arises from specific pathologies that compromise the integrity and function of the knee's lateral compartment. Identifying the root cause is crucial for effective treatment. Several conditions commonly contribute to discomfort in this region, ranging from acute injuries to chronic degenerative changes. Consequently, a spectrum of treatment options exists, tailored to the individual's condition and needs. These approaches span from conservative management to surgical interventions, each with its own role and specific indications.

The Conservative Route: Physical Therapy and Medications

When lateral knee pain is mild to moderate and stems from conditions like ITBS, minor ligament sprains, or early osteoarthritis, conservative treatment is typically the first line of defense.

Physical Therapy: A Cornerstone of Recovery

Physical therapy plays a pivotal role in restoring function and alleviating pain. Targeted exercise programs are designed to strengthen the surrounding muscles, including the quadriceps, hamstrings, and hip abductors.

These muscles are essential for knee stability and proper biomechanics. Improving range of motion and flexibility through stretching and mobilization techniques is also crucial.

Proprioception exercises help retrain the body's awareness of joint position, further enhancing stability and preventing re-injury. A well-structured physical therapy regimen can significantly reduce pain, improve function, and delay or even eliminate the need for surgery.

Medication Management: Alleviating Pain and Inflammation

Medications can be valuable adjuncts to physical therapy, particularly in managing pain and inflammation.

Over-the-counter pain relievers, such as NSAIDs (nonsteroidal anti-inflammatory drugs) like ibuprofen and naproxen, can effectively reduce pain and inflammation.

However, prolonged use should be avoided due to potential side effects. In some cases, prescription pain medications may be necessary for short-term relief of more severe pain.

Corticosteroid injections into the knee joint can also provide temporary relief from pain and inflammation. However, these injections are not without risks. Repeated injections can potentially damage cartilage. Therefore, they are typically used sparingly and in conjunction with other treatments.

When Surgery Becomes Necessary: Arthroscopic Interventions

When conservative measures fail to provide adequate relief, or when the underlying pathology is severe, surgical intervention may be considered. Arthroscopic surgery has revolutionized the treatment of many knee conditions.

Arthroscopic Surgery: A Minimally Invasive Approach

Arthroscopy involves making small incisions around the knee and inserting a tiny camera and surgical instruments to visualize and address problems within the joint.

This minimally invasive approach offers several advantages over traditional open surgery, including smaller scars, less pain, and a faster recovery.

Arthroscopic techniques can be used to address a variety of conditions, including meniscal tears, ligament injuries, and cartilage damage.

Meniscectomy: Weighing the Benefits and Risks

A meniscectomy involves the partial or total removal of a torn meniscus. This procedure is typically considered when the tear is irreparable or when conservative treatment has failed.

While meniscectomy can provide pain relief and improve function, it is important to note that removing part or all of the meniscus can increase the risk of developing osteoarthritis in the long term.

Therefore, meniscectomy is generally reserved for cases where other treatment options are not feasible.

Meniscus Repair: Preserving Knee Function

When possible, repairing a torn meniscus is preferable to removing it. Meniscus repair aims to restore the meniscus's natural function as a shock absorber and stabilizer.

However, not all meniscus tears are amenable to repair. Factors such as the location, size, and pattern of the tear, as well as the patient's age and activity level, influence candidacy for meniscus repair.

LCL Reconstruction: Restoring Lateral Stability

Lateral collateral ligament (LCL) injuries can lead to instability of the knee. In cases of severe LCL tears that do not heal with conservative treatment, LCL reconstruction may be necessary.

This procedure involves using a graft, either from the patient's own body (autograft) or from a donor (allograft), to reconstruct the torn ligament. LCL reconstruction is a complex procedure, and recovery can be lengthy. It involves a structured rehabilitation program to regain strength, stability, and range of motion.

The Importance of Individualized Treatment

The selection of the most appropriate treatment for lateral knee pain depends on a variety of factors.

The severity of the injury, the patient's activity level, their overall health, and their individual goals all play a role in the decision-making process.

A thorough evaluation by an orthopedic surgeon or sports medicine physician is essential to determine the underlying cause of the pain and to develop an individualized treatment plan. The treatment plan should be a collaborative effort between the patient and their healthcare team.

Rehabilitation: Regaining Strength and Stability

Lateral knee pain often arises from specific pathologies that compromise the integrity and function of the knee's lateral compartment. Identifying the root cause is crucial for effective treatment. Several conditions commonly contribute to discomfort in this region, ranging from acute injuries to chronic degenerative changes. Post-treatment rehabilitation is not merely a recovery period; it is a carefully orchestrated process essential for restoring optimal function and preventing future complications.

The Cornerstone: Adherence and Activity Modification

The success of any rehabilitation program hinges on the patient's unwavering commitment to prescribed exercise protocols. It's not enough to simply perform the exercises; understanding the rationale behind each movement and executing them with precision is paramount.

Activity modification is equally critical. This involves temporarily adjusting daily activities and sports to avoid exacerbating pain or impeding the healing process. Ignoring these modifications can lead to setbacks and prolonged recovery.

Taming the Inflammatory Response: RICE Protocol and Pain Management

Managing pain and swelling is a crucial initial step in rehabilitation. The RICE protocol – Rest, Ice, Compression, and Elevation – remains the gold standard for controlling the inflammatory response.

• Rest: Minimizing stress on the injured tissues.

• Ice: Applying cold packs for 15-20 minutes several times a day.

• Compression: Using a bandage to reduce swelling.

• Elevation: Keeping the leg elevated above the heart.

Beyond RICE, your physical therapist may employ other pain management strategies, such as electrical stimulation or manual therapy techniques.

The Roadmap to Recovery: Phased Rehabilitation

A well-structured rehabilitation program progresses through distinct phases, each with specific goals and criteria for advancement.

Phase 1: Pain Control and Inflammation Reduction

The primary focus is on minimizing pain and swelling. Gentle range-of-motion exercises may be introduced to prevent stiffness.

Phase 2: Restoring Range of Motion

Exercises are designed to gradually restore full knee flexion and extension. Stretching and mobilization techniques may be used.

Phase 3: Strengthening

This phase emphasizes strengthening the muscles surrounding the knee, including the quadriceps, hamstrings, and hip abductors. Progressive resistance exercises are used to gradually increase strength and stability.

Phase 4: Functional Activities

Exercises mimic real-life movements and sport-specific activities. This phase prepares the knee for the demands of daily life and athletic participation.

Gateways to Progression: Meeting the Criteria

Advancement to the next phase depends on meeting specific criteria, such as:

• Achieving a certain range of motion.
• Demonstrating adequate strength and stability.
• Experiencing minimal pain during activity.

Premature advancement can lead to re-injury and setbacks. The physical therapist will assess progress and determine when it is safe to move forward.

Preventing Recurrence: A Proactive Approach

Rehabilitation extends beyond simply recovering from an injury; it's about preventing future problems. Proper warm-up exercises, including dynamic stretching, are essential before any physical activity.

Regular stretching helps maintain flexibility and range of motion. Strengthening exercises should be continued to maintain muscle strength and stability.

Paying attention to biomechanics during activity is also important. Addressing any underlying muscle imbalances or movement patterns can help reduce the risk of re-injury. By taking a proactive approach to injury prevention, individuals can maintain long-term knee health and function.

The Healthcare Team: Who Can Help?

Lateral knee pain often arises from specific pathologies that compromise the integrity and function of the knee's lateral compartment. Identifying the root cause is crucial for effective treatment. Several conditions commonly contribute to discomfort in this region, ranging from acute injuries to chronic overuse syndromes. Navigating the healthcare system to find the right expertise can be daunting, so understanding the roles of different professionals involved is key to a successful recovery.

Assembling Your Knee Pain Dream Team

Successfully managing lateral knee pain often requires a collaborative approach. No single healthcare provider possesses all the answers. Understanding the distinct roles of various specialists allows patients to strategically build a team tailored to their specific needs.

The Orthopedic Surgeon: When Surgery is on the Table

Orthopedic surgeons are medical doctors specializing in the musculoskeletal system. They are the experts to consult regarding surgical interventions.

Their expertise lies in diagnosing and surgically treating conditions affecting bones, joints, ligaments, tendons, and muscles.

When conservative treatments fail to alleviate lateral knee pain, or in cases of severe injury (such as a complete LCL tear or complex meniscal damage), an orthopedic surgeon's evaluation becomes crucial.

When to consult an orthopedic surgeon:

• Persistent pain despite conservative management.
• Suspected ligament or meniscal tear based on imaging.
• Joint instability.
• Severe arthritis limiting function.
• Consider an opinion if other treatments are not yielding positive results after reasonable effort.

The Physical Therapist: Your Rehabilitation Guide

Physical therapists (PTs) are movement specialists. They play a pivotal role in both conservative management and post-surgical rehabilitation of lateral knee pain. Their focus is on restoring function, reducing pain, and preventing future injuries.

A PT will conduct a thorough evaluation to identify movement impairments contributing to your pain. They then develop individualized exercise programs to strengthen weak muscles (quadriceps, hamstrings, hip abductors), improve flexibility, and enhance proprioception (your body's awareness in space).

Key roles of a physical therapist:

• Develop and implement rehabilitation programs.
• Guide patients through exercises and activity modifications.
• Provide manual therapy techniques to improve joint mobility and reduce muscle tension.
• Educate patients on injury prevention strategies.

Manual Therapy Techniques:

Physical therapists use a variety of hands-on techniques to address musculoskeletal impairments. These may include:

• Joint mobilization: Restoring proper joint mechanics.
• Soft tissue mobilization: Releasing muscle tension and adhesions.
• Trigger point therapy: Addressing localized areas of muscle pain.

The Primary Care Physician: Your Initial Point of Contact

Primary care physicians (PCPs) are often the first point of contact for individuals experiencing lateral knee pain. While they may not specialize in musculoskeletal conditions, they play a vital role in:

• Performing an initial evaluation to rule out other medical conditions.
• Providing basic pain management strategies.
• Referring patients to appropriate specialists (orthopedic surgeons or physical therapists) for further evaluation and treatment.

Do not undervalue the importance of a timely and thoughtful referral. A strong relationship with your PCP facilitates effective navigation of the healthcare system.

So, that's the lowdown on lateral knee pain! Remember, if you're experiencing discomfort on the outside of your knee, especially pain stemming from the lateral compartment of the knee, don't just grin and bear it. Give your doctor or a physical therapist a shout – they can help you figure out what's going on and get you back to feeling your best!