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Physiotherapy SEEN

327 replies

VenusEnvyXX · 11/04/2024 19:17

I am concerned about the CSP's position statement on transphobia and want to explore whether members think the CSP would benefit from having it's own SEEN.

If you're not familiar with SEENs, they are a balance to the LGBTQIA+ groups, can be formally recognised and eligible for funding on an equal footing as other network groups. They exist in civil service, journalism, police, HR, city, and the NHS one is nearly ready to launch.

I do not agree with Rob Yeldham, and previously, Karen Middleton, when they say that physiotherapy has a transphobia issue. If there is evidence of this I have not seen it.

I have been contacted by a number of CSP staff and members, who share my concerns that this announcement misrepresents the law, defames members and manages to be both unnecessary and unclear.

It seems that people who are diametrically opposed to the view that sex is real and immutable are employed by and in positions of power and influence at our trade union. This is absolutely fine, it is important for a trade union to reflect its membership. I am uncomfortable with the views of activists forming policy without due process and debate. I hope to be wrong, but I suspect that might have happened in the formation of this CSP position statement.

It is difficult to speak up about these issues, people are scared of being accused of transphobia, and rightly so, the personal penalties can be high.

If you would be willing to share your views or insights with me anonymously here then I'd be grateful. Alternatively, (and if you are willing to trust that I am who I say I am!):
email - [email protected]
substack - @venusenvyxx
twitter - @gussiegrips

I am proud to have had a long career in physio and it seems to me that this is little more than a training and communication issue, which, like sex, is not complicated.

bests
Elaine Miller

Position statement on transphobia

We recognise that, like other forms of discrimination, the understanding of the manifestations of transphobia will evolve. We will need to update our position in light of experience and learning, as and when appropriate. This statement will therefore b...

https://www.csp.org.uk/about-csp/equity-diversity-belonging/position-statement-transphobia

OP posts:
Thread gallery
49
stealtheatingtunnocks · 17/04/2025 20:47

Does the CSP think that the law is a pick n mix? You don’t get to comply with the bits you like and ignore the nutty ones.

VivaVivienne123 · 17/04/2025 21:40

I think they need to grasp that this is not about the exclusion of trans people but about the protection of women’s rights…..

GiveHerEffervescence · 17/04/2025 22:10

They’ve failed to grasp that so far, safeguarding of women irrelevant to them. I’m not sure how ignoring the law is going to play out for them?

Anklesprainssuck · 01/09/2025 14:35

Anyone think the CSP is following the Sandy Peggy case / aware of the FWS outcome and think they may need to review that stance on sex base rights/ trans guidance for their members?
Or is it not a case of pigs might fly ?

munsbit · 01/09/2025 19:09

I don’t think the case against Fife will sway them. If Sandy Peggie succeeds in her claim against the NMC though, that might

VenusEnvyXX · 30/10/2025 11:12

I lost my log-in, apologies for disappearing. Much has been happening.

I'm delighted to share that I am co-author of a literature review looking at the pelvic health impacts of cross sex hormones which has been accepted as a presentation at the CSP conference in Newport next month. My academic friend and I have the chance to share the work and take questions live, and I don't mind saying that I'm rather looking forward to it.

My concern about the influence of a small group of ideologues at the CSP continues to rise - have you seen this? Organising Clinic: countering extremist hate. The framing makes me uncomfortable, as usual some groups are not mentioned.

My colleague and I hope to be able to speak to the people who are pushing the current CSP agenda and aim to work with them on ensuring that eg CSP position statements are legally literate and evidence based.

We are hoping to find like-minded members and be able to set up a group which can focus on patient-centred care, the law, and the evidence base.

To that end, I have written an essay on language and consider the CSP's use of it in my sobstack. I note that in the six months since the Supreme Court judgment the CSP has not managed to say they stand in solidarity with their female members. They want to reassure their trans members, but not explain the law has been clarified not changed.

If any of you are going to conference then please let me know!

CSP responds to Equality Act ruling

The CSP has expressed solidarity with its trans members following a high-profile Supreme Court ruling. 

https://www.csp.org.uk/news/2025-04-17-csp-responds-equality-act-ruling?utm_source=chatgpt.com

OP posts:
VivaVivienne123 · 30/10/2025 19:57

VenusEnvyXX · 30/10/2025 11:12

I lost my log-in, apologies for disappearing. Much has been happening.

I'm delighted to share that I am co-author of a literature review looking at the pelvic health impacts of cross sex hormones which has been accepted as a presentation at the CSP conference in Newport next month. My academic friend and I have the chance to share the work and take questions live, and I don't mind saying that I'm rather looking forward to it.

My concern about the influence of a small group of ideologues at the CSP continues to rise - have you seen this? Organising Clinic: countering extremist hate. The framing makes me uncomfortable, as usual some groups are not mentioned.

My colleague and I hope to be able to speak to the people who are pushing the current CSP agenda and aim to work with them on ensuring that eg CSP position statements are legally literate and evidence based.

We are hoping to find like-minded members and be able to set up a group which can focus on patient-centred care, the law, and the evidence base.

To that end, I have written an essay on language and consider the CSP's use of it in my sobstack. I note that in the six months since the Supreme Court judgment the CSP has not managed to say they stand in solidarity with their female members. They want to reassure their trans members, but not explain the law has been clarified not changed.

If any of you are going to conference then please let me know!

Good to read your update. The research on pelvic health and cross sex hormones is important work. Sadly I won’t be at the conference to see your presentation but will look out for updates.

If you’re looking for volunteers to work with the CSP to ensure fair and lawful representation for all, then I would be interested. Please let me know.

Calyx72 · 04/11/2025 07:58

VenusEnvyXX · 30/10/2025 11:12

I lost my log-in, apologies for disappearing. Much has been happening.

I'm delighted to share that I am co-author of a literature review looking at the pelvic health impacts of cross sex hormones which has been accepted as a presentation at the CSP conference in Newport next month. My academic friend and I have the chance to share the work and take questions live, and I don't mind saying that I'm rather looking forward to it.

My concern about the influence of a small group of ideologues at the CSP continues to rise - have you seen this? Organising Clinic: countering extremist hate. The framing makes me uncomfortable, as usual some groups are not mentioned.

My colleague and I hope to be able to speak to the people who are pushing the current CSP agenda and aim to work with them on ensuring that eg CSP position statements are legally literate and evidence based.

We are hoping to find like-minded members and be able to set up a group which can focus on patient-centred care, the law, and the evidence base.

To that end, I have written an essay on language and consider the CSP's use of it in my sobstack. I note that in the six months since the Supreme Court judgment the CSP has not managed to say they stand in solidarity with their female members. They want to reassure their trans members, but not explain the law has been clarified not changed.

If any of you are going to conference then please let me know!

Hiya will your presentation be online or only in-person? I would get a ticket to see your presentation.

stealtheatingtunnocks · 04/11/2025 09:06

So good, it was posted twice!

VenusEnvyXX · 09/11/2025 13:38

VivaVivienne123 · 30/10/2025 19:57

Good to read your update. The research on pelvic health and cross sex hormones is important work. Sadly I won’t be at the conference to see your presentation but will look out for updates.

If you’re looking for volunteers to work with the CSP to ensure fair and lawful representation for all, then I would be interested. Please let me know.

Thanks, @VivaVivienne123 - I will do.

We have a bit of work ready. We are aiming to build a resource for sex realist members so they know how the law supports them, find peer to peer support and know what to do if they are accused of having been seen naked in a field with the Devil. (always worth a watch)

I see the AGM proposes to class "women" as a "minoritised group" alongside "non binary" and "intersex" people. I assume these words will have definitions and that they will not use the term "intersex" which is regarded as grossly offensive by many people with disorders of sexual development - some of whom will, by the law of averages, be members of the CSP.

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OP posts:
RadFiz · 09/11/2025 19:36

Interesting that they want to widen "marginalised groups" beyond protected characteristics by including things like class.

VenusEnvyXX · 17/11/2025 17:21

I am a bit frustrated that it is really quite difficult to find the AGM motions on the website - but, yes, they seem to be keen to expand the bandwidth of what a minority is. I have a post on substack summarising my concerns and we have another drafted which we'll publish ahead of Friday's conference about our paper and its implications for the "position statement on transphobia" which seems more ideological in basis than anything peer reviewed.

substack on belonging, boundaries and bias. The last comment is interesting, someone has critiqued my essay, but I don't think his arguments address anything I actaully said.

I'm looking forward to having some frank conversations in Newport.
Don't suppose any of you are going to conference?

Belonging, Boundaries and Bias

Why healthcare governing bodies, like the CSP, need a member-led review on sex and gender

https://venusenvyxx.substack.com/p/belonging-boundaries-and-bias

OP posts:
VenusEnvyXX · 25/11/2025 11:53

update on the conference, C+P'd from the ohter thread here (https://www.mumsnet.com/talk/womens_rights/4479019-uk-physios?page=37&reply=148757847)

VenusEnvyXX · Today 11:46
Sorry to take an age to post - it's been quite a lot to unpick. Conference was great, met lots of very interesting people doing really good things, as you'd expect.
There were a couple of issues which surprised me - firstly, there was a small note on the ticket email saying that by turning up they assume your consent to being photographed and videoed...and that the CSP could digitally alter your image and use it for any purpose. Naturally, Ruth, the lead author of the paper, and I objected. Given the issues there are with men using AI in pornography this was a staggeringly naive thing to assume. It would be fine if we had confidence in what the CSP would do with our image and how this data would be stored - but as that was unclear we refused permission. Despite this, we were photographed and had to insist the images were deleted.
We attended the workshop run by the LGBTQIA+ network, which over ran into the break. There were five people on the panel plus Paul Rees, the chair - he did not introduce the panel so I don't know who they were. I was disappointed with the talks - there were three accounts of lived experience, one of which was very good and raised issues beyond the ubiquitious "list of the speaker's diagnoses, account of discomfort prior to gender interventions and then catechisms about how much better life is after gender interventions". I am grateful for anyone who is willing to talk about their personal history at a scientific conference but patient experts usually have relevance to the field - so I was surprised to not hear about the speakers experience of physiotherapy, especially as one of the panel later mentioned having had pelvic health physio and scapular pain post-double-mastectomy.
What was disappointing was that the questions from the floor generated lots of words from the panel and chair but not actual answers. One was "how do I approach a patient presenting with back pain who is binding?" There was shuffling from the panel, eyes down, an actual shrug and "yes, that's difficult". Then Paul Rees gave detail of his (entirely unrelated) MSc thesis and they moved on to another question. This is not adequate. Binding is known to be harmful (binding BMJ) and we should, as clinicians, be able and willing to discuss these issues - even if people in the room are using binders.
Our own paper was fine, though the chair told us we had to cut it because the CSP had some tech issues - which was very odd. She also limited our allocated 5 minutes of Q+A to one question - but that meant there was time left at the end of the session so all presenters did a quick panel which was very good. Here's Ruth's thread on the findings of the paper:
We said in our presentation that these are contentious issues and that we hoped people would come and talk to us afterwards. A member who is a trans man did, and was very generous in what they shared with us. The conversation was productive and I think we managed to communicate that our aim is to provide excellence in care - which requires talking about and managing unwanted effects. There were points of disagreement, as you'd expect, this member felts strongly tht women should be kind and let males into our single sex spaces because women's right to privacy is not enough to make a male person sad by excluding him. However, it was a positive chat, so much so the group invited us to go clubbing with them in Cardiff. We declined, obviously, one of my protective characteristics makes me too old for that!
The next day none of the group were willing to look at us, never mind talk to us. They were trans flags on clothing and disapproval on display, I assume they had googled us.
The AGM was awful, though most people in the room looked very pleased with the whole thing. The reports of the CSP's work lacked much in the way of mention of actual patients. There was lots of praise for commenting on global issues - none of which should be, in my mind, the business of a trade union or governing body as we do not have a foreign office. John Cowman said they had made a statement condemning islamaphobic and racist unrest in Dublin - which is interesting as that statement has been removed from their website and was made while the crime scene being investigated which is, at best, premature, and at worst, cloth eared as we could have members in Dublin who were directly impacted. Comment was made so quickly it would have been before the forensic examiner would have even seen the child (terrible story about the sexual assault of a child) I do not think this is the role of my governing body or trade union - they are not journalists, it would be good if they focussed on issues in physiotherapy and health.
Then it was time to vote on various motions - you had to pre-register on civica to do that (is that legal? Surely being a member entitles you to vote?) and many people in the room could not get the tech to work, including me. About 20 people asked for help and three others told me they gave up. All motions passed, much applause. We were told 500 people voted, much applause. I was appalled - 500 votes out of 60k+ members? This union does not have membership engagement.
I was talking to some members at the back of the room and John Cowman asked if I was coming to the Q+A session.
Now, that was interesting - there was a panel of 4 of the exec plus John Cowman, and 20 people in the room - including all of the council and Baroness Ilora. I counted four others, including Ruth and I, and she is no longer a member. I don't know how many delegates there were, I'd guess about 1500 - and 4 turned up to the Q+A. So, I'm judging - are you? Either this organisation is not engaging with it's members or its members are not engaging with it.
Questions were about why physio is badly represented in a plan - I think it was the NHS workforce plan. This was well explored, all the panel, the CEO and the Baroness commented and a plan seemed to be agreed to push things forward.
I asked how they felt about 0.8% of the membership voting in the AGM. The answer was "quite good, actually, usually there are about 100 votes". Goodness.
Then I asked about the last motion - which I thought was adding "woman, intersex, non binary and working class" to the list of "minorities" - and asked what their definition of "minority" was, and given that women are 71% of the membership and 52% of the population then how can we be a minority? There was a long silence and I got tetchy and asked "Is this silence saying that none of you know what the last motion that you asked us to vote on, and I voted against, was?"
The answer was that I had muddled the words, the motion acutally said "minoritised". I said that my point stood.
Claire Sullivan said that they were getting ahead of the trend, that women used to be 90+% of the membership but that is changing - so they added "woman" so that if they ever needed to make a special group then they could. Which sounded like nonsense to me.
"I'd be very happy to organise that. Your position is that TWAW, though?" Claire nodded "So that is fine, as long it is not set up as a single sex resource that is legal - but if I included males with a gender issue in a women's group then I'd have to also allow males who don't have a gender issue or I'd be discriminating against them on the basis of their sex under the Equality Act"
That got a lot of blank looks in response.
At some point Claire said that the position statement on transphobia would not be changing - which is odd, because anything can change if members want it. I thanked them, said it was very helpful.
A woman asked a question about occupational health not being adequately championed and that she was meeting with someone in Westminster herself. Rob Yeldham's phone rang for his taxi so he left - I've heard there's a rumour that he left in the huff while I was talking, but that is not the case.
Ruth and I then had a chat with some of the council who were very positive and seemed to understand that there is an issue that some of what is on the website is not actually legal. The new chair, Sylvia, said she has a meeting with the CEO today and would raise this with him. Ruth sent her some briefing notes.
My thinking is that we could have a woman's group with men in it, regardless of how they identify. Male physios work with women, so it is important they understand the impacts of our biology and physiology, and what our legal rights are.
I wonder, though, if there's a need for a professional group supporting members by interpreting the research, evidence and law (R.E.A.L) pertaining to sex and gender - which meets the criteria as a professional group needs to address a clinical need and I think that would. We'd need 100 members to set that up - which is a challenge as I keep hearing from people who agree, are unhappy but afraid of putting their name out there because of fear of consequences. I think people don't realise how protected they are, the law is supportive, sex factual views are legal and you are allowed to say that sex is real and sometimes matters. The way to help address that is to give members confidence in the law and guidance - and the CSP is clearly not in a hurry to do that.
We have written a "critical friend" letter which we are hoping will be a joint letter - if you are interested please get in touch. It shows the lacks of the "position statement on transphobia" which, we think, makes the CSP vulnerable as it is not legally literate, not based on reliable statistics and does not include the references we found in our state-of-the-art literature review. Here's Ruth's tweet about it.
Please do have a chat about this with anyone you know, give them my details. DM here, twitter is open (@gussiegrips), email is [email protected]. My feeling is there are a significant number of members who want to support patients who have gender related issues but the evangelical approach the CSP has adopted to this population is possibly not optimally serving them - or the membership.
Here's the leaflet we took to conference - share it with anyone interested, including people who would disagree. We really do want to talk to everyone and oppposing views are welcome. Nothing is solved without debate.
I'll put a substack up shortly with links to the resources we think might be helpful for members. I'll link that here.

Page 37 | UK Physios | Mumsnet

Please sign into CSP and look at the new iCSP discussion "Stonewall and the CSP" A great thread beginning and agreement that stonewall are problemati...

https://www.mumsnet.com/talk/womens_rights/4479019-uk-physios?page=37&reply=148757847%29

OP posts:
Calyx72 · 25/11/2025 15:22

Excellent update thank you very much.
I will get in touch as interested in supporting the ‘critical friend’ letter.

Bosky · 25/11/2025 22:31

@VenusEnvyXX Have you got another link for the Binding article please? That one goes to a "Page Not Found":
https://thorax.bmj.com/content/71/Suppl_3/A227.1)

VenusEnvyXX · 26/11/2025 13:10

Sorry about that. Here's a C+P.

https://thorax.bmj.com/content/71/Suppl_3/A227.1

Respiratory Physiology
P257 Understanding the effects on lung function of chest binder use in the transgender population
RJM Cumming1,
K Sylvester2,
J Fuld2
Abstract
Introduction Chest binders are garments used for compression of breast tissue by transgender individuals. Deleterious consequences of binder reported include shortness of breath with associated reduced exercise tolerance and speech difficulties; some have suggested lung function is monitored in users of chest binders.1 We conducted a study to investigate any respiratory deficits caused by chest binders as currently used in the transgender population.
Methods We recruited 20 participants from the transgender community. All were assigned female at birth. Ages ranged from 19–47 with median age 22; 4 were current smokers and 4 had mild to moderate asthma. All were habitual users of chest binders. Participants underwent spirometry testing and measures of chest circumference and posture with and without their own binder. The order of testing with or without the binder was random. Ethics approval was granted by the University of Cambridge.
Results Table 1 shows abnormal baseline lung function. The median FEV1/FVC is abnormally high but not acutely influenced by the binder. The standard residual of all forced spirometric values was significantly (p < 0.001) below predicted values (based on sex assigned at birth); peak expiratory flow (PEF) values were also lower than predicted. There was a significant reduction in expiratory vital capacities, both SVC and FVC (p < 0.01) when the binder was on but no other significant acute change. On average chest circumference was reduced by the binder. There was no average change in thoracic kyphosis due to high variability.
Conclusions Transgender individuals using chest binders have abnormal lung function. The acute effect of wearing the binder appears to be an overall volume reduction with little other change. Abnormal lung function in the population may indicate a chronic effect of binder usage or generally poor respiratory health. However, due to the small size and timeframe of the study no control population was tested and thus a systematic error cannot be ruled out.
View inline

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Abstract P257 Table 1
Median spirometry values acquired with the binder off vs. on. A reduction in vital capacity is seen with the binder on.
Reference
Davies S, Papp VG, Antoni C. Voice and communication change for gender nonconforming individuals: Giving voice to the person inside. Int J Transgenderism 2015;16:117–159.

https://doi.org/10.1136/thoraxjnl-2016-209333.400

https://thorax.bmj.com/highwire/markup/184046/expansion?width=1000&height=500&iframe=true&postprocessors=highwire_tables%2Chighwire_reclass%2Chighwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed

OP posts:
Bosky · 26/11/2025 13:16

Thank you! That link works 👍

2016 - so this is not even new knowledge 🤦‍♀️

VenusEnvyXX · 26/11/2025 13:27

Here's our flyer - we are thinking about next steps and open to suggestions. Post here, email or message on social media.

All views welcome, including from people who disagree.

Physiotherapy SEEN
Physiotherapy SEEN
OP posts:
VenusEnvyXX · 26/11/2025 13:27

Bosky · 26/11/2025 13:16

Thank you! That link works 👍

2016 - so this is not even new knowledge 🤦‍♀️

no, none of it is. And it's perfectly obvious.

OP posts:
VenusEnvyXX · 26/11/2025 14:20

just had a quick tot up - including myself there are 35 accounts who have commented on this thread.

Now, some of you might have more than one name, some of you might not be CSP members and some of you might disagree - and there will be lurkers watching but not commenting.

I reckon there are about a dozen TRAs on the exec and council at the CSP. I think that between this thread and those in touch on twitter, FB and linkedin - maybe we have enough like-minded people to force a discussion with the CSP whose job, it says, is to listen to its members.

I have been thinking a lot about what Claire Sullivan said in the Q+A meeting - that her position is that TWAW and the statement on transphobia will continue to stand. It's factually incorrect, it misinterprets the law and is based on census data which has been discarded as it was so flawed. So, why would she WANT it to stand?

I did tell Claire Sullivan that I did not stand for council election because John Cowman asked me not to, and a year has gone by, I have demonstrably been patient, and there has been zero progress in making the CSP adhere to the law or engage with its membership. I am running out of patience. I expect my governing body and trade union to put out information that managers and members can rely on in the workplace. It is not unreasonable to expect them to do their job properly, is it? They get paid more than physios will on the NHS.

Which is a point, there are few members of staff who are actually physios. Roughly, out of 170 members of staff about 30 qualified as clinicians. I wonder whether that is a factor?

I remain staggered that 500 votes out of 60K+ members is seen as a cause for celebration. I accept that is fairly standard for trade unions and political parties - but WHY is it accepted? If I was a cynic I'd think that is because it does not actaully suit the exec to have an engaged membership because that increases the workload.

The flip question is, of course - why are we, as a large group, so passive?

OP posts:
VenusEnvyXX · 26/11/2025 14:47

On the Other Thread, which is nearly full, there are 57 names which are not on here. So that is 92 accounts - some might be doublers, some are not members, but even so...that's not nothing.

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VenusEnvyXX · 26/11/2025 15:16

Last comment for now...Here's Jack Chew's reflections on his time at council.

Seems legit.
https://mskmag.substack.com/p/how-the-sausage-is-made-insights

How The Sausage Is Made: Insights from my two years on the CSP Council

By Jack Chew

https://mskmag.substack.com/p/how-the-sausage-is-made-insights

OP posts: