What is Gowers sign in Duchenne muscular dystrophy?

In Duchenne muscular dystrophy (DMD), Gowers sign is a characteristic physical movement used by children to compensate for proximal muscle weakness, particularly in the hips and thighs. When attempting to rise from a seated or lying position on the floor, an affected child cannot stand up in the usual manner. Instead, they must "walk" their hands up their own legs, using their arms to push their torso upright because their leg muscles lack the necessary strength to support the body's weight against gravity.1

This sign is a clinical indicator of the progressive muscle degradation associated with the absence of the protein dystrophin, which leads to weakened cell membranes in skeletal muscles. While Gowers sign is a hallmark symptom, it is often observed alongside other signs of the disease, such as a waddling gait, frequent falls, and enlarged calves caused by muscle breakdown.1