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We all know that muscles “pull” the bones like levers to make us move, but muscles can also “push”, which can be helpful to keep in mind when trying to resolve postural-pain problems.

The statement about "muscles" being able to push is not entirely accurate but if I’d said “myofascia can push”, I’m guessing many of you might not know what I’m talking about. And yes, I know. You can’t push a string. But hear me out.

Each hinge-joint for example, has muscles on the front of it and the back of it, one of which will bend the hinge, and the other which will pull the hinge straight. Hinge joints include the knee, the elbow, and the talus joint at the ankle.

The hamstring muscles at the back of the thigh bend the knee by pulling the lower leg backwards towards the thigh, and the quadricep muscles in the front, straighten the knee by pulling the lower leg forward.  This is simple lever mechanics.

However, because we are not machines and our bodies adapt to how we use them, muscle lengths can be altered from their functionally-optimal length. 

Here is a simplified example to help you understand how muscles can push joints:

If we do not kneel on the floor and sit on our heels as frequently as we bend over from the hips to pick something up from the floor, the body, being economical like it is, decides that since the full range-of-motion in the front of the thigh is not being used we don't need it, and over time the quad muscle (front of thigh) will shorten.

Now the quadricep (fascia) on the front of the knee is tighter than the hamstring (fascia) on the back of the knee, and when we stand we are more likely to lock our knees out, which pushes the joint back, resulting in the shin bone leaning back.  So hyper-extended knees signal the possibility of tight quads.

If you have a pliable rod which you have wrapped in plastic, and you tighten the plastic more on one side, the rod will bend like a bow. The tight plastic is pushing the rod into the more extensible side.

So, if someone stands with their hips forward of their ankles, the muscles behind the hips are tight, pushing the hips forward (external hip rotators, hip extensors).  

If one's pelvis is rotated to the left in standing (right side forward), the muscles in the back of that right hip are tight or overly contracted, pushing it forward creating a rotation.

If one's ribs appear shifted left in relation to the pelvis, the muscles and fascia on the right side of the ribcage are pushing it over (serratus anterior), and that muscle/fascia could use some stretching or massage.

If one's pelvis is shifted right in relation to the feet, the muscles and fascia on the left side of the pelvis are tight are pushing the pelvis right, and could use some stretching or massage.

If the ball of someone's shoulder appears forward on the ribcage and there is shoulder pain, look for tightness at the back of the shoulder and stretch that (infraspinatus, posterior shoulder capsule).

The shoulder case is interesting to me because it was always drilled into my head that a shoulder that is rounded forward is due to a tight pec minor (chest muscle) pulling the shoulder forward.

So I would always give pec minor stretches, and more often than not the results were less than satisfactory, occasionally making the shoulder pain worse.

Following through on the idea that tightness from the back is pushing the shoulder (humeral head) forward, it makes sense that stretching and loosening the front would make things worse by creating a bigger imbalance front to back.

In order to "push" the ball back into the socket, strengthening the muscles at the front of the shoulder would probably be helpful, specifically subscapularis.  Often in these cases, the push muscles (pecs, delts, triceps) are weaker than the pull muscles. 

Chest strengthening would need to be done very carefully, as we would want to avoid further stretching the front of the shoulder capsule. I use three different strategies for this. 

1. Dumb bell chest press is done on the floor so the elbows do not descend below the body resulting in a stretch of the anterior shoulder capsule.  I often don't even allow the elbows to reach the floor, and have occasionally put blocks or towel rolls on the floor so the elbows only descend to the height of the shoulder.
2. I use a close-grip dumb bell chest press to start – hands no more than shoulder-distance apart, and only widen the motion when pain is reduced. Elbows start alongside the ribs, forearms vertical.
3. Chest press and shoulder press are done starting with the palms facing each other, and as the arms reach skyward, the palms turn and face behind the head as far as is comfortable with no strain. The external rotation of the arm at the end of the range of motion stretches the lats and the chest, seems to reduce over-protraction of the shoulder-blade, and also seems to help sink the arm deep into the socket potentially stretching the posterior shoulder capsule.

Pec minor is a small chest muscle that runs from the ribs to the coracoid process of the shoulder blade (sticky-outy bit that one finds if one searches, just under the collar-bone by the shoulder). Pec minor does not attach to the arm or to the ball of the shoulder.  When it is tight, it pulls the shoulder blade up and "over" the shoulder giving the appearance of the shoulder rounding forward.

In order to discern whether the problem is a tight pec minor as opposed to the ball of the shoulder being pushed forward, check the shoulder blade in the back.  If the bottom point is sticking out, and if the shoulder blade appears high, pec minor stretching is probably in order.

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