If you have been told you have hip or knee osteoarthritis and that a replacement is the eventual answer, there is something worth knowing first: exercise therapy is the recommended first line treatment in every major clinical guideline internationally. Not surgery. Not injections. Exercise and education.

GLA:D is the structured program built to deliver exactly that, and it is one of the reasons I do this job.

Why I brought it to Core

I have been running this practice for eighteen years and I have spent a good part of that time building relationships with local GPs and orthopaedic surgeons. The conversation I kept having was about timing. People were arriving at a surgical consultation having done nothing in between, which meant the only options on the table were wait, or operate.

That is a terrible pair of options to be given when there is a third one with strong evidence behind it.

So I completed the GLA:D certification and we now run it in small groups at our Elsternwick studio. It is not the flashiest thing we do. It is probably the one that changes the most lives.

What GLA:D is

GLA:D stands for Good Life with osteoArthritis: Denmark. It was developed in Denmark, it is delivered in clinics worldwide by physiotherapists who have completed specific training, and it has been running in Australia since 2016 with data collected on every participant.

The structure is fixed: six weeks, twice a week, in small groups, plus two education sessions.

That consistency is deliberate. It means the program you do here is the same program that produced the results in the research, which is not something most exercise classes can claim.

What the six weeks actually looks like

Before you start

An individual assessment with your physiotherapist. We confirm the diagnosis, take your baseline measures, and adapt the exercises to your knees or hips specifically. This is also where we talk honestly about what is realistic for you.

The two education sessions

These sit in the first two weeks. We cover what osteoarthritis actually is, which is not the bone on bone, wearing out story most people arrive with. We cover what makes it flare and what settles it, how to manage a bad week, what the evidence says about surgery, injections and supplements, and how to keep going after the program ends.

People routinely tell me these two sessions changed how they thought about their joint more than anything else. Understanding that a painful knee is not a knee being destroyed by use is genuinely liberating.

The twelve exercise sessions

Small groups, around an hour, twice a week. The focus is neuromuscular control, meaning the way your muscles coordinate to control the joint through movement, rather than simply loading it heavier.

Everything is scaled to what you can currently do. In any given group we will have someone using a chair for support and someone loading with weights, doing versions of the same exercise.

Measurement at three points

We record outcome measures at the start, at three months and at twelve months. Pain, function, quality of life, and a walking test.

This is the part I would encourage you to care about. It means you can see whether it worked rather than relying on how you happen to feel on the day you are asked. It also means we are accountable to you.

The question everyone asks

Why exercise a joint that is worn out?

It is a completely fair question and the instinct behind it is sensible. The answer is that the state of the cartilage is only one part of what determines your pain and function, and often not the largest part.

Many people with significant changes on imaging have very little pain. Many people with minimal changes are struggling badly. Muscle strength and joint control account for a substantial amount of that difference, and unlike your cartilage, they are things we can change.

Properly graded exercise does not accelerate wear. It improves the support around the joint and reduces how much load the joint has to absorb unassisted.

Internationally, the data collected from GLA:D participants has consistently shown reduced pain, improved function and a reduction in the proportion of people who go on to want surgery. Not everyone avoids a replacement. A meaningful number delay it, and many who do proceed go in stronger, which matters for the recovery.

Who it suits

Anyone with hip or knee osteoarthritis symptoms, at essentially any stage. You do not need a scan. You do not need a GP referral. Physiotherapists can assess and diagnose osteoarthritis directly.

It suits people on a surgical waiting list particularly well, and I would encourage anyone in that position to do it. Going into an operation with better strength and control generally means a better recovery, and a number of people find their symptoms improve enough that they reconsider the timing.

Who it does not suit

I would rather tell you upfront.

If you have had a joint replacement in the affected joint already, GLA:D is not the right program and we would build you something individual. If your primary problem is inflammatory arthritis rather than osteoarthritis, this is not the program either. And if you genuinely cannot commit to twice a week for six weeks, the honest answer is to wait for a block of time when you can, because the schedule is what the evidence is built on.

Common questions

Do I need a referral or a scan?

Neither. Book an assessment directly. If you have had imaging, bring it, but we will not require it.

What does it cost and can I claim it?

Sessions are delivered by a physiotherapist and are claimable under physiotherapy extras cover. Some people are also eligible for a Medicare rebate through a GP Chronic Disease Management plan. Call us and we will give you the current pricing and help you work out what you can claim.

Will exercise make my pain worse?

Some increase in symptoms during the first couple of weeks is normal and is not causing harm. We work within an acceptable range and progress gradually. If something flares significantly, we adjust rather than push through.

How fit do I need to be?

Not fit at all. The program was designed for people with painful, stiff joints who have often stopped exercising entirely. That is the starting point it assumes.

What if I miss a session?

Life happens and we will work around it. If you know in advance that you will miss several, it is usually better to start with the next group.

What do I wear?

Comfortable clothing you can move in and supportive shoes.

What happens after the six weeks?

Most people continue into our Clinical Pilates or group classes to maintain what they have built, and we follow up your outcome measures at three and twelve months either way.

How to join the next group

Book an initial assessment, and we will confirm whether GLA:D is right for you and let you know when the next group starts. Groups run regularly and fill reasonably quickly.

Book your assessment, or call the clinic if you would rather talk it through with someone first. We are in Elsternwick and see people from across Caulfield, Elwood, Brighton and the wider south east.

I believe physiotherapy should be the first line of treatment for hip and knee osteoarthritis. Six weeks is a small investment to find out whether it works for you.