Effects of Modified Clamshell Exercises in Patients With Hip Osteoarthritis Grade Ⅱ.

Overview

This study focuses on patients diagnosed with Grade II hip osteoarthritis, a degenerative joint condition characterized by pain, reduced range of motion, muscle weakness, and functional limitations. Hip osteoarthritis is commonly assessed using the Kellgren-Lawrence (KL) classification system, with Grade II representing definite osteophyte formation with possible joint space narrowing, where conservative management is strongly recommended. Exercise therapy, particularly strengthening of the hip abductor muscles, plays a key role in improving pelvic stability, reducing pain, and enhancing functional outcomes. Clamshell exercises are widely used to activate the gluteus medius and minimus muscles, while modified clamshell exercises are designed to optimize muscle recruitment and reduce compensatory movements. A total of 54 participants with Grade II hip osteoarthritis will be included in the study and allocated into three groups. Group A will receive clamshell exercises along with conventional exercise therapy, Group B will receive modified clamshell exercises in addition to conventional exercise therapy, and Group C will receive a conventional exercise program alone. Pain intensity will be assessed using the Visual Analog Scale (VAS), which ranges from 0 to 10. Hip joint range of motion will be measured using a goniometer, and functional outcomes will be evaluated using the Hip Disability and Osteoarthritis Outcome Score-12 (HOOS-12). The aim of this study is to compare the effects of clamshell exercises, modified clamshell exercises, and conventional exercise programs to determine the most effective intervention for reducing pain, improving hip joint range of motion, and enhancing functional outcomes in patients with Grade II hip osteoarthritis.

Hip osteoarthritis (OA) is a chronic degenerative joint disorder characterized by progressive deterioration of articular cartilage, changes in subchondral bone, osteophyte formation, and narrowing of the joint space. These structural changes lead to pain, stiffness, reduced range of motion, muscle weakness, gait abnormalities, and functional limitations, ultimately affecting mobility, independence, and quality of life. Hip osteoarthritis is a common musculoskeletal condition, particularly in middle-aged and older adults, with global prevalence estimates indicating that approximately 5-10% of adults over the age of 45 are affected. Mechanical factors such as altered joint biomechanics, abnormal load distribution across the hip joint, femoroacetabular impingement, repetitive joint loading, previous trauma, and weakness of surrounding musculature play a significant role in the development and progression of the disease. Radiographic assessment is commonly used to classify the severity of hip osteoarthritis, with the Kellgren-Lawrence (KL) grading system being the most widely accepted. The KL classification ranges from Grade 0 to Grade IV. Grade 0 indicates no radiographic evidence of osteoarthritis. Grade I shows doubtful joint space narrowing with possible osteophyte formation. Grade II is characterized by definite osteophyte formation with possible joint space narrowing. Grade III includes multiple moderate osteophytes, definite joint space narrowing, sclerosis, and possible bony deformity. Grade IV represents severe osteoarthritis with large osteophytes, marked joint space narrowing, severe sclerosis, and definite bony deformity. Grade II hip osteoarthritis represents an early stage of the disease in which conservative management is strongly recommended to reduce symptoms, improve function, and slow disease progression. Exercise therapy is a core component of conservative management for hip osteoarthritis and plays a vital role in improving muscle strength, joint stability, range of motion, and overall functional performance. Strengthening of the hip abductor muscles is particularly important, as these muscles contribute to pelvic stability and optimal load transfer during functional activities such as walking and stair climbing. Clamshell exercises are commonly prescribed to activate and strengthen the gluteus medius and minimus muscles. Modified clamshell exercises involve changes in positioning or execution to enhance muscle recruitment, improve neuromuscular control, and minimize compensatory movements, potentially resulting in improved clinical outcomes.