If you or your loved one has been diagnosed with Duchenne muscular dystrophy (DMD), you may know the condition causes progressive muscle weakness. The first signs of DMD often appear between ages 2 and 4. One of the earliest and most recognizable signs of DMD is Gowers’ sign — a specific way of rising from the floor that suggests weakness in the lower body muscles.

Recognizing and understanding Gowers’ sign can help you learn more about DMD and the experiences of other families navigating a diagnosis.

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What Is Gowers’ Sign?

Gowers’ sign refers to a movement pattern that children with DMD often use to stand up from the floor. Due to weakness in their thigh, hip, and pelvic muscles, a child will push off their legs with their hands, “walking” their hands up their thighs to rise to a standing position.

Researchers have noted that a child who moves into a face down or crawling position before standing — older than age 3 — may have an underlying neuromuscular condition, such as muscular dystrophy.

Gowers’ sign usually develops around age 3 or 4, though it may be subtle at first and become more noticeable as muscle weakness progresses. This key clinical sign of DMD is often one of the early indicators that lead to diagnosis.

What Does Gowers’ Sign Look Like?

Children with Gowers’ sign may have difficulty rising from the floor and generally take longer to do so than children without muscle weakness. Their movement typically follows these steps:

1. The child shifts into a face down position, possibly starting on their hands and knees.
2. They place their hands on the floor for support and push their lower body upward, positioning themselves in a stance similar to the downward dog yoga pose.
3. They move their hands closer to their feet and begin “walking” their hands up their legs.
4. They push off their thighs with their hands to fully stand. At this stage, their calves may appear larger than expected due to pseudohypertrophy — a buildup of fat and scar tissue that makes the muscles look enlarged, even though they’re weaker.

Mild Presentations of Gowers’ Sign

The steps above describe the most common presentation of Gowers’ sign, but milder cases may look different. A child may use just one hand to push off their thigh, or they might stand with their hands on the floor and push off without touching their thighs. These different ways of assisting themselves to stand are considered variations of Gowers’ sign.

All the variations indicate proximal muscle weakness (weakness in muscles close to the body, like those in the hips and thighs). The severity of Gowers’ sign often correlates with the degree of hip and thigh muscle weakness.

Researchers studying Gowers’ sign have noted that a child who moves into a face down or crawling position before standing — older than age 3 — may have an underlying neuromuscular condition, such as muscular dystrophy.

In adults, Gowers’ sign can appear in conditions like inclusion body myositis, polymyositis, and Becker muscular dystrophy (BMD), though the muscle weakness is often less pronounced than in DMD.

How Common Is Gowers’ Sign?

Motor symptoms — difficulties with movement, walking, or coordination — are among the earliest signs of DMD. Gowers’ sign is one of these key movement-related symptoms.

Medical literature consistently describes Gowers’ sign as “very common” in DMD.

In one study of nearly 1,000 people with DMD, 93 percent showed motor symptoms at the time of diagnosis. The average age of diagnosis was 4 years. While specific data on the prevalence of Gowers’ sign is limited, medical literature consistently describes it as “very common” in DMD.

What Causes Gowers’ Sign in People With DMD?

DMD causes progressive muscle weakness, making activities like running, jumping, climbing stairs, and standing up from the floor more difficult. Children with DMD often use the Gowers’ sign movement to compensate for weakness in their legs and core muscles.

This muscle weakness is caused by a mutation (change) in the DMD gene, which prevents the body from producing dystrophin — an essential protein that helps maintain muscle structure and function. People with DMD lack functional dystrophin entirely, leading to ongoing muscle damage, progressive weakness, and eventual muscle atrophy (loss).

Becker muscular dystrophy is also caused by mutations in the DMD gene, but some dystrophin is still produced. As a result, BMD tends to be milder and progress more slowly than DMD.

In DMD, muscle weakness usually starts in the legs and hips, making it harder to stand up. Using the hands to walk up the legs shifts some of the effort away from weakened leg and hip muscles to the arms and shoulders, where strength is often better preserved.

Symptoms That Often Accompany Gowers’ Sign in DMD

Most people with DMD experience progressive difficulty with walking and other mobility challenges. Other DMD signs and symptoms that might occur alongside Gowers’ sign include:

• Delayed walking milestones (later than typical)
• Difficulty running or jumping
• Toe-walking or a waddling gait (a side-to-side swaying motion)
• Frequent falls
• Enlarged calf muscles
• Other delays in motor skills or coordination

Importance of Recognizing Early DMD Symptoms

While DMD can’t be prevented or cured, treatments and therapies can help extend and improve your loved one’s life. Early detection is key to identifying and diagnosing DMD. Recognizing possible symptoms, like Gowers’ sign, can help lead to an earlier diagnosis, which may allow for interventions that help preserve muscle and heart function.

Some research has found that the average delay between the onset of DMD symptoms and diagnosis is around 2.5 years.

In people with DMD, muscle degeneration begins at birth, even before symptoms appear. Medications may be used to help manage symptoms. Because treatments are most effective when started early, a timely diagnosis is crucial.

However, research shows that diagnosis is often delayed. One study conducted at a neuromuscular center in England found that, on average, parents first noticed early signs of DMD at 2.7 years (32.5 months), but the average age of diagnosis was 4.3 years (51.7 months). The researchers reported that the delay between parental concern and an official diagnosis averaged 1.6 years. Other research has found that the average delay between the onset of DMD symptoms and diagnosis is around 2.5 years.

For children with DMD, parents are often the first to notice something may be wrong. Steps toward diagnosis typically begin with a physical and neurological examination, followed by diagnostic tests such as:

• A creatine kinase blood test — Checks for high levels of creatine kinase, an enzyme released when muscle tissue is damaged
• Genetic testing — Looks for mutations in the dystrophin gene that cause Duchenne muscular dystrophy.
• In some cases, a muscle biopsy — Involves examining a small sample of muscle tissue for signs of dystrophin deficiency or damage to muscle cells

Parents and caregivers play a critical role in recognizing early signs like Gowers’ sign, discussing concerns with doctors, and advocating for genetic testing. Increased awareness can help lead to earlier diagnosis and access to treatment that may improve quality of life.

Other Conditions That Cause Gowers’ Sign

You may wonder if it’s possible to have Gowers’ sign without DMD or what other conditions might cause it. Gowers’ sign isn’t exclusive to DMD. It can occur in a range of diseases and conditions that cause weakness in the muscles of the hips, thighs, and lower body, such as:

• BMD
• Limb-girdle muscular dystrophy
• Spinal muscular atrophy
• Juvenile arthritis
• Inclusion body myositis
• Hypokalemic periodic paralysis

Next Steps After DMD Diagnosis

Coping with a loved one’s DMD diagnosis can feel overwhelming, but advances in care have greatly improved treatments and quality of life. Your care team will guide you through treatment options, medications, physical therapy, and assistive mobility devices, such as wheelchairs.

It’s natural to feel stressed, anxious, or even overwhelmed after a diagnosis. Many parents and caregivers of children with DMD experience emotional challenges, including anxiety or depression. Remember, you are not alone — seeking mental health support or connecting with others in DMD support groups can provide encouragement and guidance. Taking care of your emotional well-being can also help you better support your child.

Join the Conversation

On myMDteam, people share their experiences with muscular dystrophy, get advice, and find support from others who understand.

Have you noticed Gowers’ sign in your child? What are some questions you have for other families and caregivers? Let others know in the comments below.