At Willis Street Physiotherapy and our partner social enterprise "The Physio Spot" we welcome clients of all genders, for all injury and pain conditions. We also offer specific gender diversity services.
We have developed a gender diversity service in consultation with experts in this field and our service is integrated with the public health system - you may have been recommended us by your GP, or you can request a referral from your GP to access this service.
In recognition of the fact gender diverse clients often have financial hardship then we are happy to offer fully subsidised appointments (with funding coming from our social enterprise the Physio Spot). In order to access the fully subsidised appointment you must get a GP referral. If you are happy to self fund, you do not require a GP referral to receive treatment.
Further information relating to how gender diversity can impact your musculoskeletal system, as well as advice on things you can do that may help you manage / reduce pain and discomfort are below.
Wearing a binder or corset, changing the way you hold yourself or move, and undergoing surgery are all very common and are important for many people. It is important though to know the risks so you can minimise the chance of developing pain, injuries or difficulty breathing. All of these risks can be managed. The purpose of this info sheet is not to tell you what to wear or how to feel comfortable, it is to help to you to minimise the risks associated with these common practices.
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Wearing a binder or a corset is important for many people. However, there are a few risks to be aware of:
- Constant compression can cause the gradual development of bruising or stress fractures in your ribs. This can lead to a break which carries some risk of damaging the lungs sitting right behind the rib cage.
- Rib restriction causes you to breathe differently and to use the muscles of breathing in a way they are not designed for. Over time these changes can become habitual so the new breathing pattern continues even when you’re not wearing a binder or corset. The new breathing pattern can cause painful muscle tension and also reduce how much oxygen is available to your lungs.
- Rib restriction limits your ability to expand your lungs therefore reducing the amount of oxygen available to your body.
If wearing a binder or corset while exercising the reduced oxygen can cause people to lose consciousness. Try to choose a binder or corset which is as loose as you can while still providing the shape you need. The less compression it creates the longer you will be able to wear it for without encountering problems. Do not use duct tape or ACE bandages to bind as these materials are not elastic and therefore carry far greater risk of serious injury than a properly designed and fitted binder. See Wellington Binder Exchange - Facebook link. There are no absolute guidelines about the maximum number of hours per day binders and corsets can be worn safely. The use of binders and corsets is important and for some people a very necessary garment to wear for the majority of the day. However, depending on your needs it is a good idea to try to limit the number of hours you spend wearing these garments. Even if that just means taking it off at the end of the day when you’re on your own, and taking it off to sleep. If you are able to take it off for exercise it will make exercise safer. However if this is not possible for you, try to have someone you trust around while you exercise so they can look after you if you do lose consciousness. If you start to develop pain in your ribs or changes to your breathing while not wearing the garment, it is a good idea to seek advice from a physiotherapist or GP trained in this area. You can find out more about our breathing product here
It is common for people to hunch their shoulders down and forwards in order to minimise the appearance of their chest or shoulders. It is ok to do this for periods of time during the day, but it can lead to painful muscle tension, reduced flexibility, and loss of strength and control of back and shoulder muscles if this posture is sustained over a long period of time. Over a period of months or years this can lead to
- Injury to the neck and back, shoulders, or jaw
- Compression of nerves causing numbness or loss of muscle control
- Painful muscle tension leading to headaches
- Difficulty building the desired shape and build after surgery (e.g. building shoulder musculature after top surgery) These problems are compounded if you are also wearing a binder or corset on a regular basis.
A good way to think about why holding a particular posture for a long period of time can cause problems is to imagine what would happen if you tapped the same place on your arm over and over again. It wouldn’t hurt at first, but if you did it for long enough it would begin to bruise and become painful. If you ignored the pain and kept going the skin might break down and start bleeding and just the weight of a shirtsleeve on the injury would cause you pain. But the problem is not that you are tapping with too much force or that you shouldn’t wear long sleeves, the problem is that the force is so repetitive that your skin cannot recover fast enough in between taps and as a result begins to break down. The constant force placed on the same structure in your body hour after hour by a sustained posture works the same way. The posture is not the problem, it’s how much time you spend in it. Things can be done to balance out the position you’re holding yourself in. This will minimise the chance that it will become a problem over time. Many people need to hunch forwards or slouch their shoulders when they’re out in public, but if you are able to find times when you can straighten up and lean back for a while, it will go a long way to minimising the risk of injury.
- Lie on your stomach for a while, propped up on pillows to extend your upper back and hold your shoulders back
- When you’re on your own try to sit or stand in a more upright position, bringing your shoulder blades gently towards each other extending your upper back and bringing your shoulder blades together does not need to be a stretch per say, just getting out of a hunched position for a while is all you need to do. There may be some days when you can’t manage to do this at all and others when you feel more able to. Every bit counts, just do what you can when you can.
It is common for people to consciously change the way they walk, often trying to swivel their hips more or less, especially when in public. It is also common to suddenly change footwear, (e.g. start wearing high heels regularly for the first time) which changes the way the muscles in your legs are required to work. There is nothing wrong with trying to do this, but any changes in your walking style or footwear need to be made gradually so that your muscles and tendons have time to keep up with the change in load. A good way to think about this is in terms of exercising at the gym. If you’re going to start doing push-ups for the first time you might only be able to do five before your muscles are too tired to keep going. You wouldn’t then try to do five again the next day - your muscles would be sore and need a rest. If you tried to force yourself to do hard exercise on a tired muscle the muscle might tear, or you might do the movement in a way that injures something else. It would probably be a few days before you’d feel ready to do the push-ups again. During this time the muscles and tendons in your arms and shoulders would have recovered from the exercise and grown a bit stronger so they’re able to keep up better next time. When you change your walking style you change the demands placed on different muscles. If these changes occur too suddenly without enough rest and recovery time in between, it can lead to low back, hip, and knee injuries. The key is to make sure the change is gradual and that you try to have rest days where you go back to your previous walking style or shoe style for a while. This can be really hard to do sometimes, but just like with postural changes – do what you can, when you can.
Not everyone decides to have surgery. However, if you do there are some things you can do to minimise your risk of problems, reduce your recovery time, and make it quicker and easier to get the shape and movement you want afterwards. Taking care of your body as described above will make recovery from surgery much easier. Maintaining the strength and flexibility around your rib cage, shoulders, back, and hips during the months prior to surgery, will make it much easier for you to hold yourself and move the way you want to afterwards. As a common example, take a look at the impact of sustained hunched posture on the outcomes after top-surgery:
- People who hold themselves in a hunched position for many years prior to surgery can become very tight across the front of their shoulders and neck, and very weak at their upper back.
- After top-surgery they may want to pull their shoulders back and stand up taller, but are often so tight they cannot easily do this.
- After surgery they may go the gym to start building definition in their shoulders and strengthen their upright posture, but due to the muscle tension they’ve built they can’t perform the exercises correctly and safely. The chest and rib cage may be so tight that breathing properly during exercise is more difficult.
- This leads to injury, nerve compression, and difficulty achieving the shape and build they are looking for Physiotherapists who have undergone specific training can help you to restore the posture, flexibility and strength you need after surgery. If you can minimise how tight you get prior to surgery it will be much easier for you. Sensitisation Sensitisation is the word we use to describe skin becoming hypersensitive to touch, so that even gentle contact is experienced as pain or discomfort. This is caused by changes to the nerves in the skin and sometimes in the spinal cord. It is commonly seen in association with musculoskeletal pain and discomfort, and is therefore common in the transgender community. However, it is something which can be treated and in many cases normal sensation can be restored.
If you are experiencing changes in sensation it is a good idea to talk to a physiotherapist who is trained in this area, at Willis Street Physiotherapy we have Sophie, Chris, Nick and Maarama who are all experised treating gender diverse clients.