What is binding and why do people do it?

Binding is a process of using garments to compress chest tissue to create a flatter appearance.

It is typically practised by transgender men and non-binary individuals assigned female at birth (also known as AFAB), but may be practised by anyone who wants to bind.

Binding can serve a number of purposes, including: 

•    relieving gender dysphoria
•    experimenting with gender expression
•    expressing themselves in a way that feels good.

For some people, binding is very important and they will bind every day. Others might only bind occasionally for specific occasions (like wearing particular items of clothing or meeting new people).

Some will continue to use binding for the rest of their life, while for others it might be a temporary solution until top surgery can be performed.

In this case, top surgery involves the removal of chest or breast tissue to create a flatter appearance.

It is often expensive, not covered by health insurance and inaccessible to many trans folk.

How do people bind?

There are many different ways of binding, including commercial binders, tight sports crop tops and binding tape.

Commercial binders: Commercial binders are binders that have been designed specifically for binding.

They are generally made from nylon and spandex and come in different styles, including mid torso and full torso.

Some common brands include trans-owned business gc2b, Underworks (which also does a swim binder) and Amor binders for a more sensory-friendly option. Commercial binders can be costly, which is often a barrier for people who bind.

Tight sports crop tops: These can be from any brand and are a great option for those new to binding and wanting to experiment before purchasing a commercial binder.

Folk with larger chests often report that layering two crop tops works better than wearing just the one, though this should not be done with commercial binders.

Binding tape: Binding tape is very similar to KT tape. Tape is applied to the chest and pulled to the side.

A benefit of this method is that the ribs and back can move more freely. However, the adhesive can cause skin irritation. A popular brand of binding tape is TransTape.

Holly Shuttleworth.

Case study

Twenty-three-year-old Kai presents to your clinic with thoracic and neck pain. They are wearing an oversized hoodie. They are a student studying medicine at university.

Their pain gets worse at the end of the day, especially if they have had a long day studying.

You want to assess them and ask them to remove their shirt. When they do, you notice that they are wearing a very compressive sports bra, flattening their chest almost entirely.

In your objective assessment, you observe that they have a forward head posture, depressed and protracted scapulae, restricted thoracic movement and shallow breathing.

You decide that their pain is due to postural weakness and long hours studying.

You recommend some strengthening exercises, educate them about getting up frequently while studying and book a follow-up appointment in two weeks.

When they return, they tell you that they have been doing their exercises and moving around while studying but their pain hasn’t improved at all.

This cycle continues and suddenly it’s been six weeks with no change in symptoms.

During one of your sessions, you notice a rainbow patch on their bag and you remember an article you read in InMotion about binding in the LGBTQIA+ community.

By this point, you have built up enough rapport that you feel comfortable asking whether or not they are binding and they say that they are.

Finally, you can start to make progress with your treatment.

What are the health implications of binding?

Binding, while beneficial to trans men’s and non-binary folk’s mental health, does come with potential risks. These include:
•    thoracic and cervical pain
•    bruised or fractured ribs
•    costochondritis
•    difficulty breathing
•    pulmonary complications such as atelectasis and pneumonia
•    skin irritation, blistering, bleeding and infections.

If binding is causing them pain, shouldn’t they stop?

Binding is extremely important to those who bind. For many, it affirms their gender and reduces gender dysphoria.

If someone had to stop, it might limit their life in other ways such as reducing social connection, decreasing work or education attendance and reducing their ability to leave the house.

If you were to ask Kai to stop binding, they might ignore your advice and stop physiotherapy altogether.

Ultimately, Kai would have left your clinic with no improvement in pain and with feelings of being dismissed.

So, what can someone do instead?

Managing binder-related pain is not one-size-fits-all. It is important that individuals practise safe binding to minimise complications.

Safe binding generally includes:
•    wearing a binder that fits
•    binding for no longer than eight hours
•    not binding at night
•    using recommended methods such as those listed earlier. Methods such as bandages or duct tape
are not appropriate
•    not wearing binders during intense exercise 
•    taking breaks throughout the day if possible
•    removing the binder if in pain or short of breath
•    avoiding irritation in hot weather by using baby powder or wearing a
T-shirt underneath the binder
•    avoiding binding when unwell, especially if there are any respiratory symptoms.

As a physiotherapist, how can I help my patient?

It is important to validate your patient and demonstrate an understanding that ‘not binding’ is simply not an option for these clients.

A thorough assessment is important and every patient will have a different experience.

Most patients will benefit from stretching and strengthening exercises to reverse the adopted posture as well as mitigating other risk factors such as prolonged sitting.

It is also important to create an environment where this can be discussed in the first session so that we, as physiotherapists, can be effective from the outset. For this to happen, there needs to be trust in the therapeutic relationship.

There is no set way to do this but here are a few quick tips:
•    introduce yourself with your pronouns. For example, ‘My name is Kate; my pronouns are she/her. What pronouns do you use?’
•    demonstrate inclusivity through posters or flags in your practice
•    use gender-neutral language on your paperwork and allow space for people to share their pronouns and chosen name (which may not be their legal name)
•    use a trauma-informed approach.

Visit here and here for more information about binding, including safety.

>> Holly Shuttleworth APAM is a non-binary physiotherapist who splits their time between research in paediatric disability and private practice, with a particular interest in neurological disabilities. They are a member of the APA Victorian Branch Council and used this position to drive the creation of the LGBTQIA+ Advisory Panel.