Adapting GLA:D®: 3 Real-World Lessons for Clinicians

The GLA:D® program has become a widely adopted global framework for managing hip and knee osteoarthritis, with impressive success in both implementation and patient outcomes.

In many ways, the structure and strong evidence behind it give us confidence; we know we’re delivering something proven to work. And honestly, sometimes it’s a relief not to build a full treatment plan from scratch!

While the structure is valuable, real-world practice comes with its own complexities. This blog highlights three common scenarios where flexibility goes a long way, and how GLA:D® expert Sarah Kroman adapts the program in a real-life case.

If you want to see exactly how expert physio Sarah Kroman delivers the GLA:D® program, with specific challenges related to a real patient case, watch her full Case Study HERE. With Case Studies you can step inside the minds of experts and apply their strategies to get better results with your patients. Learn more here.

#1 – They already know about exercise (and have tried it)

Compared to when the program was first developed, these days, most people coming into GLA:D® have heard that exercise helps with osteoarthritis, and many have already tried it.

This can bring a different kind of challenge: instead of patients being unaware of the benefits of exercise, they may already be skeptical. They’ve tried it. It didn’t work. So why would this be any different?

So instead of educating about the benefits of exercise, you may find yourself needing to advocate for GLA:D®-based exercise itself. Sarah’s approach is to reframe what GLA:D® actually is. Yes, it’s exercise, but it’s not just strengthening, or “go move more.” It’s structured, progressive, and based on neuromuscular training principles. That distinction matters. It’s not about just moving, it’s about how you move. And the confidence this builds over the course of the program is undeniable.

That subtle shift in the conversation helps patients stay open, even when they come in doubtful. And for us as clinicians, it’s a reminder that our role isn’t just to prescribe exercise, but to give it meaning and context.

#2 – Flare-ups shake confidence (and affect timing!)

Pain flares are common, especially in the early stages of GLA:D®, and for many patients, they feel like a red flag: “This means it’s not working,” or worse, “I’m making it worse.” This is especially true of patients who have tried exercise before.

Understandably, it can be really demotivating for patients. And if we’re honest, they can make clinicians second-guess too. But it’s important to stay calm and educate patients that this is simply feedback we can use to tailor management.

Sarah shares a great example of managing a flare-up without losing momentum. Rather than pausing the program or pulling back dramatically, she used small, thoughtful adjustments. Most importantly, she kept the patient moving and kept the focus on reassurance. Watch her explain this in the video below from her Case Study:

It’s easy to feel time pressure, especially when flare-ups happen early on. You want to progress the patient through the program in those first six weeks, but don’t fall into that trap!

It’s not about getting as far as possible, as fast as possible. It’s about helping the patient learn how to adapt to their symptoms, continue at a manageable level, and truly understand how to progress or regress when needed.

Help patients learn the process, not just follow instructions.

#3 – The end of the program isn’t the finish line

While the structured nature of the GLA:D® program gives it a clear endpoint, it shouldn’t be framed as the finish line for the patient.

Although patients may come in with the three-month mark in mind, it’s important to try to shift the narrative; the goal isn’t just to complete GLA:D®; it’s to build habits, confidence, and self‑management that last well beyond the program, creating long-term change.

Celebrating progress throughout the program, and at the three‑month mark, is important, but so is looking ahead. The real focus should be on how patients carry these strategies into their everyday lives, confidently navigating future challenges on their own. And if they need a little extra time to fully grasp these concepts? So be it, extend the program if the patient would benefit from it.

See Sarah explain her patient’s outcomes, and what changes she commonly sees at the three-month mark in this video from her Case Study:

Wrapping up

GLA:D® gives us a strong, evidence-based structure, but no structure replaces the need for clinical judgement.

Whether it’s reframing what “exercise” means to a skeptical patient, adjusting mid-program for a pain flare, or supporting someone beyond graduation, our role is to personalise the pathway without abandoning the principles.

Sarah’s case is a great example of what that looks like in practice. Watch her full Case Study to see it all in action.