Evidence-based exercise programme for knee osteoarthritis Singapore (2022)

One of the things that irk us the most is when seemingly authoritative health organisations put out advice that are not congruent with best evidence practice. This often lead patients to behaviours that ultimately worsen their conditions. In our previous blog post, we discussed how unscientific advice does cause harm.

The advice in concerned today is from National University Hospital, Singapore. In their article relating to osteoarthritis, they advocated against exercise that involve weight bearing. While we do appreciate how weight bearing exercises can aggravate the symptom experience for some osteoarthritic patients, there is no good reason for them to entirely avoid weight bearing exercises. In fact, this may worsen their recovery.

GLA:D Programme: Your pain solution for knee and hip osteoarthritis?

knee pain singapore, xray wear and tear
This is a x ray of a 57 year old teacher who suffered from knee pain She had knee pain for most of her adult life due to an injury as a teenager Her knees showed signs of severe degeneration since her early 40s She was also sedentary and overweight She described her knee pain as 910 This patient was put on the wait list for a total knee replacement surgery While on the waiting list for knee surgery she started to exercise under professional supervision After a year she described her pain as 110 and was subsequently removed from the waitlist

We don’t offer GLA:D programme in its entirety at Square One Active Recovery. However, the exercise solution we provide is very similar to the GLA:D programme.

Our recovery programmes are 12 weeks consisting of two sessions with our chiropractor Singapore as well as 22 sessions with a certified exercise trainer. The GLA:D programme is 8 weeks of 14 to 15 sessions.

Both our programmes focus on exercise and education.

The GLA:D programme has been adopted across the world in Denmark, Canada, and Australia. There are numerous peer reviewed journals supporting its efficacy. Patients who attended the osteoarthritis treatment reported less pain, being able to walk further and/or faster, as well as being able to perform more chair sit-to-stand. These improvements are DIRECTLY relevant to patients with knee osteoarthritis!

Knee osteoarthritis treatment can include weight bearing exercises

old woman kettlebell, knee pain singapore, knee arthritis

We want to point out the GLA:D Programme straight up because it includes weight bearing exercises, and has helped tens of thousands of people with osteoarthritic knee. This is why we think poor medical advice cause harm. By telling people they should avoid exercises that could very well be their pain solution, they are delaying recovery for patients with knee osteoarthritis.

Some of the weight bearing exercises in the GLA:D Programme include step ups, knee sliders, chair sit-to-stand, bridges, and also cycling!

In our opinion, it doesn’t make sense to avoid weight bearing exercises because most of our daily life activities are weight bearing. A good treatment for knee osteoarthritis will have to address this. Instead of avoiding putting weight on your knees, what you want to do is to train your knees so it can take weight.

This can be done through strength training and and improved neuromuscular performance of the knees.

Exercises for knee arthritis

We get that all of you are unique individuals and have your own unique pain experiences. With that in mind, it’s impossible for us to come up with a one-size-fits-all exercise list that will work for all of you. This is why professional help is important. A personalised recovery programme can help you achieve recovery outcomes that is not possible with generic ad hoc exercises.

The exercises we have included below is likely to help you. However, in the rare event that it aggravates your symptom experience, please stop doing them, and seek medical help. Our chiropractor will be able to help you develop your own exercise programme that is specific to your condition and state of fitness.

Pelvic lifts or elevated glute bridges

The pelvic lifts, or sometimes known as glute bridges, is a great exercise for strengthening and conditioning of the hamstring. If starting at an elevated position is too challenging, you can always choose to start from the ground first.

If you find that pushing your heels into the surface triggers your knee pain, you can try a calf contact instead. For some of you, this will reduce the aggravation to your knees.

  • To start, lie on the ground with your feet on an elevated surface.
  • Slowly lift your pelvis off the ground by pushing your heels into the surface.
  • Once you have reached your desired height, slowly let your pelvis down to the start position.

This exercise doesn’t require you to put weight into your knees the same way walking or climbing stairs does. So, if you have pain with those activities, and are feeling frustrated by how most exercises hurt, this exercise may be a good choice for you.

Even if you do experience pain at the start, remember you can change the contact point. Feel free to rest on your calves instead of digging your knees into a bench. It’s 100% okay!

Remember, it’s more important to find an exercise you can do than to worry over the exercises you cannot do. While pain during an exercise alone is not always bad for you, it’s safer to do exercises that do not aggravate your pain experience if you are exercising unsupervised.

When in doubt, seek professional help. Our chiropractor will be able to help you navigate your knee pain to help you find an exercise programme that is suitable for your case.

Leg sliders for knee pain


Leg sliders is a great exercise to improve your knee’s neuromuscular function. In doing so, you may start see improvements in knee stability and symptom-free range of motion.

If you are doing this exercise for the first time, it would be a good idea to limit the movement to one plane of movement. For example, you may want to only go front and back or side to side only. If you are not confident of going both forwards and backwards, try just going forwards alone or backwards alone. That’s totally okay! It’s not about how much you can do at the start. It’s about finding a starting point that you are comfortable with. With time and practice, you can expect your movements to improve.

The second thing to note is the knee angle. Depending on the state of your arthritis, you may find joint angle/knee position more comfortable than others. Our recommendation is that you find the position your knee is most comfortable in, and performed the sliders while your knee is locked in that position. It will be a good idea to make sure there’s at least some flexion (i.e., soft bend in your knee) at all times. It’s okay if you want to go for more bending. However, try to avoiding locking your knee out if possible.

  • To start, stand upright with a towel under one foot.
  • Slowly slide the towel out in your chosen plane of movement. It is important to not overreach and work within a range that you are comfortable with.
  • Once you have reached your desired range, slowly slide your foot back to the start position.

You may notice that it’s challenging to keep your knee position fixed with this exercise. If that’s the case, reduce how far out you slide with your foot. It’s more important to start with a range that you are comfortable with!

I have tried your exercises and I am not better!

If the exercises above are not helping you, don’t be discouraged! There are thousands of exercises out there that we can use to help you with your recovery. At the end of the day, recovery is indeed complex and what you need is a personalised recovery programme that is designed for your specific condition and fitness.

Also, exercise alone is not enough to give you a full recovery. Remember the GLA:D programme? Education is also a big part of your recovery. In fact, 20% of the programme is focused on teaching patients about their knee condition!

A whole person approach, that is a combination of exercise, education, and lifestyle change is what it will take for you to find true freedom from pain.

Chiropractic treatment for knee osteoarthritis

A lot of you may be tempted to seek traditional chiropractic adjustments for your knee pain. However, at this point, there’s no credible research that suggest that spinal adjustments (or even knee adjustments) could help with your arthritic pain.

It may surprise you but chiropractors are trained musculoskeletal health experts that can help you with your knee rehabilitation needs. In fact, exercise has been part of chiropractic since its founding days.

chiropractic clinic singapore

With our personalised approach to pain management, all of you will see improvements in your knee condition! Be it improvements in pain, function, strength, or mobility, our recovery programme has helped many patients with their arthritic knees.

For some of you, you may even continue with weightlifting!


Frustrated by the lack of results-driven and ethical chiropractic clinics in Singapore, Chiropractor Jesse Cai found Square One Active Recovery to deliver meaningful and sustainable pain solutions.

Our goal? To make our own services redundant to you.

*We do not offer temporary pain relief such as chiropractic adjustments, dry needling, or any form of soft tissue therapy.