Chest Binding and the Role of the Physical Therapist: A Commitment to Care

Transgender, nonbinary, and gender-diverse (TNBGD) individuals experience significant inequities in health, access to health care, and participation in physical activity for a myriad of reasons, including gender dysphoria and the physical effects of gender-affirming practices like chest binding. Physical therapists have the requisite clinical skills to evaluate and treat these individuals, potentially enhancing overall health and wellness while reducing barriers to physical activity. Binding is a common practice for many TNBGD individuals, often performed to achieve improved congruence between an outward physical appearance and one's gender identity. Given the typical frequency and duration of binding, negative binding-related symptoms such as thoracic or rib pain, shortness of breath, and postural changes may occur. Physical therapists can be the provider of choice in minimizing the symptom burden and adverse effects of binding, but as a profession, we must improve inclusive care practices, deepen our understanding of the physiologic impacts of binding, and implement culturally responsive care plans tailored to the needs of TNBGD patients. Increased access to inclusive physical rehabilitation may improve lifelong health, promote physical activity, and mitigate health inequities in this population. Clinicians can purposefully advertise their preparedness and willingness to serve lesbian, gay, bisexual, transgender, queer, intersex, asexual, and 2-spirit patients and work to understand and address disparities in health care access and quality. As a profession, we must continue to evolve to meet the needs of society, especially those who face systemic barriers and marginalization.