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 Gower’s sign — a specific way of rising from the floor that suggests weakness in the lower body muscles.

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

What Is Gower’s Sign?

Gower’s 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.

93 percent of children with DMD experienced motor symptoms when they were first diagnosed, according to one study.

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

What Does Gower’s Sign Look Like?

Children with Gower’s sign may have difficulty rising from the floor and generally take longer to do so than children without muscle weakness. When a child displays Gower’s sign, the movement typically follows these steps:

1. The child shifts into a face-down position, possibly starting on their hands and knees.
2. The child places their hands on the floor for support and pushes their lower body upward, positioning themselves in a stance similar to the “downward dog” yoga pose.
3. The child moves their hands closer to their feet and begins “walking” their hands up their legs.
4. The child pushes off their thighs with their hands to fully stand up. 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 are weaker.

Mild Presentations of Gower’s Sign

Although the steps described above are the most common presentation of Gower’s sign, milder cases may look different. Sometimes, a child may use only 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 still considered variations of Gower’s sign.

Gower’s sign usually appears around age 3 or 4.

In all of these variations, Gower’s sign indicates proximal muscle weakness (weakness in muscles close to the body, like those in the hips and thighs). The severity of Gower’s sign often correlates with the degree of hip and thigh muscle weakness.

Researchers studying Gower’s sign have also noted that if a child moves into a face-down or crawling position before standing — past the age of 3 — this can be an indicator of an underlying neuromuscular condition, such as muscular dystrophy. In adults, Gower’s sign can also appear later in life 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 Gower’s Sign?

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

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 old. While specific data on the prevalence of Gower’s sign is limited, medical literature consistently describes it as “very common” in DMD.

Causes of Gower’s 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 Gower’s 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 in BMD, some dystrophin is still produced. As a result, symptoms tend to be milder and progress more slowly compared to DMD.

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

Common Symptoms That Accompany Gower’s Sign in DMD

Most people with DMD experience progressive difficulty with walking and other mobility challenges. Other possible signs and symptoms of DMD that might occur alongside Gower’s 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 cannot be prevented or cured, treatments and therapies are available that can help extend and improve your loved one’s life. When it comes to identifying and diagnosing DMD, early detection is key. Recognizing possible symptoms of DMD, like Gower’s sign, can help lead to an earlier diagnosis, which may allow for interventions that help preserve muscle and heart function.

In people with DMD, muscle degeneration begins at birth, even before symptoms appear. Medications like corticosteroids, ACE inhibitors, and beta-blockers may help slow the progression of muscle loss and heart muscle weakness. Because these treatments are most effective when started early, 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). This study reported that the delay between parental concern and an official diagnosis averaged 1.6 years. Other research has found the average delay between onset of DMD symptoms and diagnosis to be 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, genetic testing, and in some cases, a muscle biopsy.

Parents and caregivers play a critical role in recognizing early signs like Gower’s 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 Gower’s Sign

You may wonder if it’s possible to have Gower’s sign without having DMD or what other conditions might cause it. Gower’s sign is not 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. In addition to DMD, Gower’s sign may also be seen in:

• Becker muscular dystrophy
• 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 advancements in care have greatly improved treatment options 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.

Talk With Others Who Understand

On myMDteam, the site for people with muscular dystrophy and their loved ones, members come together to ask questions, give advice, and share their stories with others who understand life with muscular dystrophy.

Have you noticed Gower’s sign in your child? What are some questions you have for other families and caregivers? Share your experiences in the comments below or on your Activities page.