Moving Better, Moving Forward

A professional and experienced physiotherapist, Nadine is passionate about providing current best practices for first and second-line treatment of hip or knee OA. The options are so much better now then they used to be!

What should be one's course of action when diagnosed with hip or knee OA or when one is vulnerable to developing it? 

There is a very distinct path of care that research has long supported. It is time for the work that we do with our patients to reflect that path.

The path of care includes three lines of treatment, meant to be followed sequentially. Lines 1 & 2 are non-operative and should be fully explored and maximized before moving onto the final line of joint replacement surgery.

As our knee and hip OA treatment approaches become more consistent and streamlined, one can hope that those who need to access the final line of care can do so more quickly as those who are successfully managing their OA joints with the first two lines continue to do so.

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Hip and Knee OA Treatment Pyramid

For many years, good research has advised how hip and knee osteoarthritis should be managed. Guidelines have been very consistent in the following recommendations:

  • The first line of treatment for ALL patients with hip or knee OA is education, exercise and weight loss.
  • SOME patients may need more. That second line of treatment could include medications, aids and devices (such as braces and orthotics) and more individualized therapy.
  • In those FEW cases where the non-surgical first and second lines of treatment aren’t proving sufficient, the next step is to pursue surgical consultation. This is considered the third-line of treatment.

We know that too many hip and knee OA patients don't receive adequate exposure to the long-term tools to self-manage their arthritic joints. Luckily, the tide has really turned in recent years.



GLAD - Very useful and beneficial program!

I found this to be a very useful and beneficial program for my osteoarthritis in my knees. It's repetitions of five different exercises that I do twice a week and I have no more pain in my knees whatsoever. It's also good for hip exercise as well. I've really benefited from this program and find it easy to find time to do it and it is well worth it. Hopefully, I can avoid any knee surgery in the future.

Madelaine Koenigsberg, Vancouver

My OA therapy experiences!

I participated in the GLA:D program with Nadine last year for help with osteoarthritis in my right knee. I was impressed with her personal style and surprised by how effective the sessions proved to be. The combination of educational components and neuromuscular exercises delivered two valuable benefits.

First, they helped trigger a noticeable and sustainable improvement in my knee.

Second, they provided the tools for self-managing my arthritis. The biweekly in-class sessions helped me understand my condition and learn exercises specifically designed to avoid pain and improve mobility. Once the GLA:D program finished, it was easy to integrate the techniques into my daily exercise regimen. I've continued the routines at home using online resources and a few inexpensive pieces of equipment. I really appreciate having the tools I need to handle my arthritis on my own. Of course, there's no guarantee that my condition won't deteriorate over time. Yet even if that happens, the knowledge and techniques Nadine provided will still be very helpful in dealing with whatever medical or surgical treatments may become necessary.

Nadine is friendly, knowledgeable and professional in her approach. During the COVID pandemic, she provided very small classes in a safe environment. She focussed on each patient's particular needs and provided a solid foundation for self-managing osteoarthritis. I can highly recommend both her and the GLA:D program.

Chris A, Vancouver