Gower's sign

Gower’s sign (maneuver) is a maneuver used by patients with muscle weakness to arise from a supine or seated position on the floor.(1-3) It particularly characteristic of Duchenne’s and Becker’s muscular dystrophies. Because of marked weakness of the hip and spine extensors, patients push with their hands to "climb up” their legs. The video shows a boy with Duchenne’s dystrophy proudly performing the act of simply standing up, something he will soon be unable to do. The segment is part of an illuminating video on the timeline of Duchenne’s dystrophy.(4)

Patients with less severe hip girdle weakness may display fragmentary forms of the maneuver and it is helpful to watch for these. Recording the time it takes to arise from a seated position on the floor is helpful in following the progression or resolution of lower extremity weakness. A patient’s ability to arise from the floor of course depends on age and agility. Michael Brooke, in his classical and invaluable textbook A Clinician’s View of Neuromuscular Disease analyzed the subcomponents of Gower’s maneuver.(1) Patients with mild weakness may display only a few telltale elements. The patient first turns to gets on all fours, then straightens the knees to thrust the derriere into the air in what is known as the “butt first” maneuver, forming an arch with the buttocks at the apex. Then he places one hand on a knee, creating support with both feet and one hand, the “tripod sign.” With a full Gower’s sign the other hand and knee are used and the patient pushes on the knees and then the proximal thighs as he climbs his legs to the erect position.

Servais and Aubert have provided a wonderful historical video of a child with DMD showing a Gower’s sign as well as toe-walking and pseudohypertrophy.(5)

References

1. Brooke MH. A clinician's view of neuromuscular diseases. 2nd ed. Baltimore: Williams & Wilkins, 1986.

2. Campbell WW. Clinical signs in neurology: a compendium. Philadelphia: Wolters Kluwer Health, 2016.

3. Campbell WW. DeJong's the neurologic examination, 7th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2013.

4. https://www.youtube.com/watch?v=OG23yakedNM, created by Helen Posselt, PT, used with permission

5. Servais L, Aubert G. Images in clinical medicine. Muscular dystrophy. N Engl J Med. 2014;371:e35 http://www.nejm.org/doi/full/10.1056/NEJMicm1007790