By Ramneet Shergill, Senior Physiotherapist, I Motion Physiotherapy Ringwood East.
If you have been told you have osteoarthritis in your knee or hip, there is a reasonable chance the conversation ended with two options: manage it with painkillers, or wait until it is bad enough for a joint replacement. That framing leaves out the thing that clinical guidelines actually recommend first, which is a structured program of education and exercise. GLA:D is one of the best studied versions of exactly that.
Osteoarthritis is not simply your joint wearing out
The wear and tear description has stuck around for decades, and it is unhelpful for two reasons. It suggests the joint is a tyre with a fixed amount of tread left, and it implies that using it will use it up faster.
Neither holds. Osteoarthritis involves the whole joint, including cartilage, bone, the joint lining and the muscles around it. It is an active process, not a passive erosion, which means the joint responds to what you ask of it. Loading a joint sensibly is one of the ways you help it, not a way you accelerate its decline.
This matters because the belief that movement causes damage is itself a barrier to recovery. People reduce activity, the surrounding muscles weaken, the joint tolerates less, and pain becomes more frequent. Breaking that loop is most of the work.
Where GLA:D came from
GLA:D stands for Good Life with Osteoarthritis: Denmark. It was developed by Danish researchers and introduced there in 2013, then brought to Australia in 2016 through La Trobe University, where it runs as a not for profit initiative rather than a commercial franchise.
The point of standardising it was to close the gap between what osteoarthritis guidelines recommend and what people actually receive. Exercise, education and weight management are first-line care in Australian guidelines, yet many people are offered scans and medication first. GLA:D packages the recommended care into a defined program that gets delivered the same way each time, with outcomes tracked in a national registry.
What the program involves
The structure is set by GLA:D Australia and must be delivered by clinicians who hold current GLA:D certification. A GLA:D based rehabilitation program follows the same four stages.
An initial assessment. Two simple physical tests are recorded: a thirty-second chair stand test and a forty metre walk test. These give you a starting number rather than a vague sense of how you are travelling, which matters more than most people expect when you are reassessed later.
Two group education sessions. Roughly sixty to ninety minutes each. The first covers what osteoarthritis is, what influences it and what the treatment options genuinely are. The second covers exercise, managing everyday activities and self-management.
Twelve supervised exercise sessions. Around an hour each, twice a week. These use neuromuscular exercise, which trains the control and quality of movement rather than just raw strength. Groups are kept small, usually four to six people per clinician, so the exercises can be adjusted to your joint and your goals.
A follow-up assessment at three months. The same two tests are repeated, goals are reviewed, and you plan what comes next. Participants also complete online questionnaires at the start, at three months and at twelve months, which feed the registry.
Who it suits, and who it does not
GLA:D is designed for people with symptoms of hip or knee osteoarthritis. You do not need a formal diagnosis on a scan, and you do not need a GP referral to start. Symptoms can be mild or long-standing.
It is generally not the right starting point if your joint pain has another cause, if you have had recent significant trauma to the joint, or if another health issue makes group exercise unsafe for you at the moment. That is what an initial assessment is for, and it is worth doing before you commit to any program. If land-based exercise is too provocative early on, warm water exercise can be a useful bridge until you tolerate more load.
What the first fortnight tends to feel like
Some increase in joint soreness in the first week or two is common and is not a sign of harm. The usual guide is that soreness which settles within about a day, and which does not build week on week, is acceptable. Pain that climbs steadily or lingers well into the next day means the load needs adjusting, not that the program is wrong for you.
Most people are looking for change over weeks rather than days. The registry data from the Australian program has consistently reported improvements in pain, function, quality of life and pain medication use across participants, though your own result will depend on your starting point, your other health conditions and how consistently you attend.
If surgery is already on the table
A structured exercise program is not an argument against joint replacement. For some people surgery is the right call, and going in with stronger legs and better movement control generally makes rehabilitation afterwards more straightforward.
For others, several months of well-delivered exercise and education changes the picture enough that surgery moves further down the list. Both outcomes are legitimate. Knowing which one applies to you is easier after you have given first-line care a genuine attempt, rather than before.
Either way, recovery after a joint replacement sits alongside osteoarthritis on the list of musculoskeletal conditions we treat, so the exercise work you do beforehand is rarely wasted.
Frequently asked questions
Will exercising a joint with osteoarthritis wear it out faster?
No. Osteoarthritic joints respond to appropriate loading in much the same way healthy tissue does, and inactivity tends to make symptoms worse rather than protect the joint. The skill is in matching the load to what your joint currently tolerates, which is why supervision helps early on.
Do I need a scan or an X-ray before I start?
Not usually. Osteoarthritis is diagnosed largely on your symptoms, your history and a physical assessment. Imaging findings correlate poorly with how much pain people experience, and plenty of people with significant changes on a scan have very few symptoms.
I am already on a surgical waiting list. Is there any point starting now?
There can be real value in it. Improving strength and movement control before an operation gives you a better platform for rehabilitation afterwards. It also gives you clearer information about what your joint can do, which some people find changes their thinking about the timing of surgery.
How long until I notice a difference?
Most people are working in a timeframe of weeks. The program runs its exercise component over six weeks with a formal reassessment at three months, which reflects how long meaningful change in strength and joint control actually takes.
Do I need my GP to refer me?
Not for a standard private appointment. You can book directly. A GP referral becomes relevant if you are claiming through a compensable scheme or a chronic condition management plan, and we can talk you through which pathways may apply to your situation.
Ready to find out whether your knee or hip is suited to this?
The honest answer to whether a structured osteoarthritis program will help you is not something you can settle from an article. It depends on which joint, what your symptoms do across a day, what you have already tried and what you want to get back to doing.
That conversation takes one appointment. Call 0428 187 899 or email info@imotionphysio.com.au to arrange an assessment at 116B Mt Dandenong Road, Ringwood East VIC 3135, or book through imotionphysio.com.au.