Gowers’ Sign

Gowers’ Sign

What is Gowers’ sign?

Gowers’ sign is a movement pattern that can occur when someone with weakness around the hips, thighs or trunk tries to stand up from the floor.

A person may:

• Roll or turn onto their front

• Push themselves up using their hands and arms

• Bring their feet underneath them

• Place their hands on their thighs

• Walk their hands up their legs to help push themselves into an upright position

This movement pattern happens because the muscles around the hips, pelvis and thighs are not strong enough to easily lift the body into standing. The person therefore uses their arms and hands to compensate for the weakness.

Gowers’ sign is named after Sir William Richard Gowers, a neurologist who described the movement pattern in people with muscle weakness.

Is Gowers’ sign a condition?

No. Gowers’ sign is a clinical sign rather than a diagnosis.

It can indicate weakness of the proximal muscles, particularly around the hips and thighs. It is commonly associated with conditions that cause muscle weakness, including some forms of muscular dystrophy, but it can also occur with other neuromuscular or muscle conditions.

If a child or adult is showing Gowers’ sign, further assessment may be needed to understand what is causing the underlying muscle weakness.

What conditions can cause Gowers’ sign?

Gowers’ sign is particularly well known in Duchenne muscular dystrophy (DMD), where progressive weakness of the muscles around the hips and thighs can make getting up from the floor increasingly difficult.

It can also be seen in other conditions associated with proximal muscle weakness, including:

• Becker muscular dystrophy

• Limb-girdle muscular dystrophies

• Some congenital myopathies

• Inflammatory muscle conditions such as dermatomyositis

• Pompe disease

• Other neuromuscular conditions

The presence of Gowers’ sign alone does not mean that someone has muscular dystrophy.

If you have noticed Gowers’ sign in your child, it is important to speak with your GP, paediatrician or another healthcare professional who can arrange appropriate assessment if needed.

When might Gowers’ sign be noticed?

Gowers’ sign is often first noticed in childhood by parents, carers or professionals working with a child.

You may notice that a child:

• Struggles to get up from the floor

• Uses their hands to push up from their thighs

• Takes longer than other children to stand

• Finds running, jumping or climbing stairs difficult

• Trips or falls more frequently

• Becomes tired during physical activities

• Has difficulty keeping up with their peers

However, Gowers’ sign can also occur later in childhood or adulthood depending on the underlying condition.

What does Gowers’ sign look like?

The classic movement involves using the arms to compensate for weakness in the lower body.

Other movement patterns may sometimes occur alongside Gowers’ sign, depending on the underlying condition, including:

• A wider-based walking pattern

• A waddling gait

• Increased movement or arching through the lower back

• Difficulty running or jumping

• Difficulty climbing stairs

• Frequent trips or falls

• Difficulty getting up from low surfaces

• Reduced endurance during physical activity

These signs are not specific to Gowers’ sign itself and should always be considered alongside the person's wider presentation.

What does Gowers’ sign tell us about movement?

Gowers’ sign can provide an indication that the muscles used to extend the hips and knees and stabilise the trunk may be weak.

For some people, this weakness may remain relatively stable. For others, particularly where it is associated with a progressive neuromuscular condition, strength and physical function may change over time.

This can affect everyday activities such as:

• Getting up from the floor

• Getting out of a chair

• Climbing stairs

• Walking longer distances

• Running and jumping

• Getting in and out of bed

• Participating in PE and sport

• Playing with friends

• Completing everyday activities independently

The impact will depend on the underlying condition and the individual's abilities.

Why is early assessment important?

Gowers’ sign is not a diagnosis, but noticing a change in how someone moves can be an important reason to seek further assessment.

This is particularly important if a child is:

• Losing physical skills they previously had

• Becoming increasingly tired

• Falling more frequently

• Struggling to run, jump or climb stairs

• Finding it increasingly difficult to get up from the floor

• Showing progressive changes in strength or mobility

A healthcare professional can assess the person's strength, movement, development and other symptoms and decide whether further investigations or referral to a specialist team are needed.

How can physiotherapy help?

Physiotherapy does not treat the underlying genetic or medical cause of Gowers’ sign.

However, when someone has an underlying neuromuscular or muscle condition, physiotherapy can play an important role in supporting movement, function, comfort, independence and participation.

The approach depends on the underlying diagnosis and the person's individual needs.

Strength and muscle function

Where appropriate, physiotherapy can help maintain functional muscle strength and movement.

For people with muscle-wasting or neuromuscular conditions, exercise needs to be carefully considered. The aim is not simply to make muscles work harder, but to support useful movement without causing excessive fatigue or overwork.

Activities may focus on functional skills such as:

• Standing

• Sit-to-stand

• Transfers

• Walking

• Reaching

• Playing

• Everyday activities

Stretching and flexibility

Some neuromuscular conditions can lead to muscle tightness or reduced joint movement.

Physiotherapy may include appropriate stretching, positioning and movement strategies to help maintain flexibility and reduce the risk of developing contractures.

Mobility and walking

For people who are walking, physiotherapy can support:

• Walking pattern

• Balance

• Walking efficiency

• Endurance

• Falls prevention

• Safe use of mobility aids

As mobility needs change, physiotherapy can also support the safe introduction and use of walking aids, wheelchairs and other mobility equipment.

Posture and positioning

Postural changes can develop in some neuromuscular conditions.

Physiotherapy can provide advice around positioning, seating and movement and, where appropriate, work alongside orthotists and other professionals regarding equipment such as splints or ankle-foot orthoses.

Functional skills

We focus on meaningful activities that are relevant to everyday life.

For a child, this might include:

• Getting up from the floor

• Standing and walking

• Climbing stairs

• Getting on and off the floor

• Playing

• Joining in with PE or sport

For an adult, this could include:

• Transfers

• Getting around the home

• Stairs

• Community mobility

• Wheelchair skills

• Maintaining independence

Monitoring changes over time

Where Gowers’ sign is associated with a progressive condition, regular physiotherapy assessment can help monitor changes in:

• Strength

• Range of movement

• Posture

• Walking

• Balance

• Transfers

• Fatigue

• Functional abilities

This can help identify changes early and allow the physiotherapy programme and wider support to adapt.

Hydrotherapy

Hydrotherapy is a form of physiotherapy delivered in a warm-water pool.

The buoyancy of the water can reduce the amount of weight placed through the body, creating a supportive environment for movement and exercise.

Depending on the person's diagnosis, abilities and goals, hydrotherapy may be used to support:

• Movement

• Strength

• Flexibility

• Balance

• Coordination

• Walking and stepping

• Cardiovascular fitness

• General physical activity

The water can make some movements easier or more comfortable, while its resistance can be used to provide gentle strengthening.

For children, hydrotherapy can also provide an engaging environment where therapeutic movement can be incorporated into purposeful play.

Hydrotherapy is not appropriate for everyone, so suitability is assessed on an individual basis.

Specialist equipment at Positive Steps

At Positive Steps, we have a range of specialist rehabilitation equipment that may be incorporated into physiotherapy sessions where appropriate.

Equipment is selected according to the person's diagnosis, abilities, goals, fatigue levels and stage of rehabilitation.

MOTOmed

The MOTOmed provides assisted or active repetitive movement of the arms and legs.

It can provide an opportunity for repetitive movement and physical activity where conventional exercise may be difficult.

The MOTOmed is wheelchair accessible and can be incorporated into an individual's wider rehabilitation programme where appropriate.

EzyGain Treadmill

The EzyGain treadmill uses body-weight support to provide a controlled environment for walking practice.

For someone who is able to walk but has difficulty with strength, balance or endurance, it may provide an opportunity to practise walking with an appropriate level of support.

Walking speed and support can be adapted according to the individual's abilities and goals.

BlazePods

BlazePods can be used to create interactive activities that encourage movement, balance, coordination and reactions.

For children, they can turn therapeutic activities into engaging games, encouraging reaching, stepping, weight shifting and movement.

Activities can be adapted to the individual's abilities and progressed as appropriate.

Hypervibe

The Hypervibe uses whole-body vibration and may be incorporated into a rehabilitation programme where clinically appropriate.

Depending on the person's presentation and goals, it may be used alongside other activities focusing on muscle activation, strength, balance and weight-bearing.

Choosing the right equipment

Not every person with Gowers’ sign or an underlying neuromuscular condition will need or benefit from every piece of equipment.

Our physiotherapists assess each person's presentation, diagnosis, abilities and goals before deciding which equipment or activities may be appropriate.

What does physiotherapy look like at Positive Steps?

There is no standard physiotherapy programme for someone with Gowers’ sign because Gowers’ sign itself is not a diagnosis.

We work with children and adults with a range of conditions that can cause muscle weakness, from people who are independently mobile through to those who use walking aids, wheelchairs or other equipment.

Our sessions are tailored around:

• What the person can currently do

• Their underlying diagnosis

• What they want to achieve

• What matters most in everyday life

• Their energy levels and fatigue

• Their home, school, work and social environment

For children, therapy may involve purposeful play and activities that work towards developmental and functional goals.

For adults, sessions may focus on maintaining mobility, independence, strength, transfers, fatigue management and participation.

Working with the wider team

When Gowers’ sign is associated with an underlying neuromuscular or muscle condition, physiotherapy is often one part of a wider multidisciplinary approach.

Depending on the diagnosis, this may include neurologists, paediatricians, specialist neuromuscular teams, occupational therapists, orthotists, speech and language therapists, cardiologists and other healthcare professionals.

At Positive Steps, we value working alongside individuals, families and the professionals involved in their care to ensure physiotherapy complements their wider management.

Little Steps and Positive Movements

For younger children working towards movement milestones, our Little Steps sessions provide fun, play-based group opportunities to work on movement, strength, balance and confidence.

For adults living with neurological or muscle-wasting conditions, our Positive Movements class provides a supportive group environment to work on strength, balance, mobility and confidence alongside others.

What are the goals of physiotherapy?

The goals of physiotherapy will depend on the underlying condition and the individual's needs.

They may include:

• Maintaining functional strength

• Supporting balance and coordination

• Maintaining flexibility and joint movement

• Reducing the risk of secondary complications

• Supporting safe movement

• Maintaining walking and mobility where appropriate

• Supporting safe use of mobility aids or wheelchairs

• Managing fatigue

• Supporting posture and positioning

• Maintaining independence

• Supporting participation in school, work, hobbies and social activities

• Providing education and advice for individuals and families

• Adapting rehabilitation as needs change

How can Positive Steps help?

Gowers’ sign can be an important indicator of underlying muscle weakness, but it is not a diagnosis in itself.

If someone has an underlying condition causing muscle weakness, appropriate physiotherapy can help them manage changes in movement, maintain function and participate in the activities that matter to them.

At Positive Steps, we work with children and adults with a range of neurological and neuromuscular conditions, providing personalised physiotherapy that changes as their needs change.

Our aim is to help every person move with as much comfort, confidence and independence as possible.

Always finding what can be done.

If you or your child is experiencing difficulty getting up from the floor, changes in movement or other signs of muscle weakness, speak to your GP or healthcare professional for appropriate assessment. If an underlying condition has been diagnosed and you would like to discuss physiotherapy, please get in touch with the Positive Steps team.

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Find out more

If you are looking for further information about Gowers’ sign or an underlying neuromuscular condition, your GP, paediatrician or specialist healthcare team can provide advice about appropriate assessment and diagnosis.

For people who have been diagnosed with a neuromuscular condition, organisations such as Muscular Dystrophy UKcan also provide information and support for individuals and families.

Gowers’ sign can occur in several different conditions, so information about the specific diagnosis will usually be more useful than information about Gowers’ sign alone.