Pathomechanics of Gowers’ Sign: A Video Analysis of a Spectrum of Gowers’ Maneuvers

Abstract

The classically described Gowers' sign is usually a late finding. However more subtle forms of Gowers' sign including mild hand pressure against the thigh and prone crawl position should be recognized by clinicians to initiate additional diagnostic tests.

Bridging the Gap: An Osteopathic Primary Care–Centered Approach to Duchenne Muscular Dystrophy

“…18 The average age of initial positive sign for DMD patients is around 5.5 years but can occur as early as 2 years. 19,20 While these are some of the most common presenting signs and symptoms, DMD's more devious symptoms typically manifest later. Integrating these examination findings with patient history may be helpful in narrowing the differential diagnosis and informing the osteopathic physician as to which diagnostic tests or symptomatic treatments will be most useful.…”

Surface EMG to assess arm function in boys with DMD: A pilot study

“…To compensate for the reduction in muscle capacity, boys with DMD often use compensatory 250 movements like the Gower's sign (Chang and Mubarak, 2011). One of the compensatory movements that is often seen in the upper extremity is the use of elbow flexion during shoulder abduction.…”

Sir William Richard Gowers (1845–1915) and his eponym

“…1 and cover image). In moderate cases, the prone crawl position and extension of all four extremities is used [8].…”

“…The most important feature of the Gowers' sign is adoption of a prone position before standing. Children who had a positive Gowers' sign almost universally turned prone first in rising from a supine position to standing up [8]. This position reduces the forces required for knee extension and typical co-activation of multiple muscle groups in the rising action.…”

“…Heel contracture and equines posturing often are evident, but also serve to improve the knee extension moment. However, when the equine becomes too severe or when hip and/or knee flexion contractures develop, the patient cannot arise without an external support of a chair or wall [8]. This is why the patients use their hand to push on the knees and so lift up the trunk ("climbing up oneself") [7].…”