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GLA:D® - an education and exercise program for people with hip or knee osteoarthritis.

Updated: Feb 9, 2021

What is the GLA:D® Program?

GLA:D® Australia is a program for all individuals who experience any hip and/or knee osteoarthritis symptoms, regardless of severity.

You may participate in the GLA:D® Australia program if you have a hip or knee joint problem that resulted in visiting a health care provider.

The GLA:D® Program Consists of:

  • A first appointment explaining the program and collecting data on your current functional ability

  • Two education sessions which teach you about OA, how the GLA:D® Australia exercises improve joint stability, and how to retain this improved joint stability outside of the program

  • Group neuromuscular training sessions twice a week for six weeks to improve muscle control of the joint which leads to reduction in symptoms and improved quality of life

GLA:D® Program Background

Osteoarthritis , particularly of the hip and/or knee, affects 1 in 11 Australians which translates to 2.2 million people. Osteoarthritis can be influenced by modifiable factors such as previous joint damage, being overweight, repetitive heavy work, weak muscles. It can also be affected by irreversible factors such as age, sex and heredity. Osteoarthritis develops slowly over many years and can affect structures like joint capsule, menisci and ligaments.

Primary clinical guidelines for the treatment of hip and/or knee osteoarthritis is patient education, exercise and if required, weight loss as the first line of treatment. However, in Australia these recommendations are not followed prior to seeing an orthopaedic surgeon.

The GLA:D® program represents an evidence based initiative that follows current recommendations for the treatment of knee and hip osteoarthritis. This includes patient education and a neuromuscular exercise program that is conducted 2 times a week for 6 weeks.

Individuals with knee or hip osteoarthritis are treated by a certified GLAD physiotherapist. Whereas patients are invited to participate in two patient education sessions prior to commencing the program. These sessions contain information about osteoarthritis and treatment options. The exercise program includes twice per week sessions for 6 weeks of supervised neuromuscular exercise that can be conducted in a small group or individually. Supervised exercise is often more effective and it is highly recommended to be completed in a group format.

GLA:D® Use and Relevance

The GLAD program has the potential to improve quality of life in individuals with mild, moderate and severe osteoarthritis of the hip or knee that may delay or prevent the need for surgery. The program will also allow the health care sector to identify patients from their baseline symptoms and target the treatment to the individual.

How common is Osteoarthritis?

Osteoarthritis is more common than high blood pressure or diabetes. It is actually the most common lifestyle disease in people who are older than 65. About 2 million Australians have hip or knee osteoarthritis and 1.5 million individuals with this condition consult with their GP each year. Whereas persistent hip and/or knee pain is the early sign of osteoarthritis.

What is Osteoarthritis?

Osteoarthritis is a lifelong disease that affects the whole joint where symptoms could begin without any obvious reason. The most common reason for the progression of the disease is individuals not being active as they age. Cartilage on the ends of the bones change in structure, continually to thin over time and can affect the tissues surrounding the joint such as the capsule, ligaments, muscles and bone. Osteoarthritis is often described as an “wear and tear disease” which should be avoided since this leads many people to believe that they cannot or should not be physically active. However, cartilage needs moderate load through physical activity in order to regenerate itself. Focusing on the structure of the cartilage is unhelpful since pain and disability associated with the condition is complex. In fact, scans such as x-rays or MRIS are no longer recommended for individuals with osteoarthritis.

Pain related Disability (Hip and/Or Knee)

Factors that contribute osteoarthritis pain and disability are complex. Although the structural changes to cartilage may play a role, there are many other factors which can contribute to patients symptoms.

Some of the following can make symptoms worse but are modifiable:

  • Being overweight

  • Muscle weakness

  • Fatigue and being inactive

  • Poor sleep

  • Stress, depression and feeling isolated

  • Fear of damage and lack of joint confidence

  • Negative beliefs and mood

The following can also make symptoms worse but are not modifiable:

  • Age

  • Gender

  • Heredity

Signs of Osteoarthritis

Osteoarthritis usually starts in one joint where symptoms develop slowly and may completely stop which depend from person to person. Stiffness is one the first signs to show particularly in the morning or after sitting down for a long period of time (less than 30 minutes). It later progresses to pain which usually occurs only during weight bearing. In the later stages there may be pain at rest and at night. Swelling may occur surrounding the affected joint which could be managed with a steroid injection, however these are usually short lived that last about one to 4 weeks. Interesting however, the pain associated with osteoarthritis is usually not derived from the cartilage but the bone, ligaments, tendons and muscles. Usually symptoms are random and can vary with often no link to a particular event.

Common problems that are associated with hip/knee osteoarthritis:

  • Putting on socks and shoes

  • Standing up from a chair

  • Prolonged standing or walking

  • Going up and down stairs

  • Running

  • Household activities

  • Gardening

  • Leisure activities and sports

Osteoarthritis treatment Pyramid

Primary treatment strategies should aim to reduce symptoms and improve joint function. Every individual seeking care for joint pain should be offered education, exercise and weight reduction if required. If these strategies alone do not lead to a satisfactory outcome then secondary treatment should be offered.

Secondary treatment strategies should include the ones offered in the primary treatment as well as pain medication, TENS, manual therapy, braces, shoe insoles and in some instances injections. Additionally at Saltfleet Clinic we offer photobiomodulation therapy for pain relief and inflammation reduction. However, secondary strategies alone cannot address the factors that contribute to pain and disabilities. If the primary and secondary strategies are not satisfactory, then the patient should trial tertiary treatment.

Tertiary treatment strategies should be used with individuals with very severe symptoms or those who did not get satisfactory results with the previous treatment options. Tertiary strategies include joint replacement or osteotomy.

Exercise, Physical activity and Osteoarthritis

Physical activity is good for everyone and is an important part of managing osteoarthritis. Physical activity can occur during leisure activities (walking, sport) or occupation. However, you may not be able to control load on your body during these activities.

Therapeutic exercise can be designed to work on many things to help people with osteoarthritis. GLAD is a therapeutic exercise program that includes neuromuscular movements that can improve the way you move and gives you more confidence to do other exercises. The exercises in GLAD are designed to improve muscular endurance and strength to help you perform daily activities such as standing up from sitting and walking on stairs.

Why is exercise important for osteoarthritis?

Cartilage in the knee or hip requires appropriate load in order for it to regenerate itself. When the joint is loaded and unloaded, synovial fluid is pumped in and out of the cartilage which stimulates new development of cartilage. This leads to an improvement in shock absorbing capacity. Inactivity or excessive load can cause imbalances between the developmental and degradation of cartilage. Starting an appropriate exercise program early will have a greater effect on the development of cartilage compared to an individual beginning at the severe stages of osteoarthritis.

How to exercise with knee or hip osteoarthritis?

Having strong muscles helps stabilise the joints and improve confidence to complete other activities you need to. This includes using the right muscles at the right time with the appropriate force, makes it easier to control movements and complete tasks. It is also important to give the body time to recover and rebuild itself between exercise classes. This is why the GLAD program sessions are spread out over the week.

If you are an individual who is suffering with hip or knee osteoarthritis have yourself an enquiry with our trained GLAD physiotherapist at the Saltfleet Clinic.


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