In the backroom of a red-brick Capitol Hill rowhouse, Frances Reed laid out yoga mats, rollers and blocks, setting up for a class later that day. The space had the look and feel of a traditional yoga studio, with the sound of crickets playing from a sound machine in the background.

But as Reed prepared an agenda for the class, it became clear it was something entirely different.

“Welcome to self-massage for binding,” Reed wrote on the wall with a dry-erase marker, jotting down techniques that students would learn: chest opening, rib release, upper back release.

The class is a workshop for people who bind — a practice that involves wearing a tight sports bra or other constricting undergarment to help flatten the chest, sometimes for extended periods of time. For people who identify as transgender or gender-nonconforming and were assigned female at birth, binding can be essential to appearing more masculine — or simply feeling more comfortable in their own bodies.

But for some people, especially those who constrict their chest for many hours a day, sometimes over several years, the practice can take a serious physical toll, leading to sharp muscle pain, shortness of breath and bad posture.

That’s why Reed, a massage therapist who identifies as genderqueer and uses the pronouns they and them, started teaching these classes about six years ago at Freed Bodyworks, the Capitol Hill wellness center Reed founded that caters to the LGBTQ community, including gender-nonconforming people.

The monthly classes are aimed at giving people who bind tools and techniques to help open their chest muscles and ease their discomfort.

“We provide a place where, for two hours, people are in here only with others experiencing the same thing,” Reed said. “They find out other people are in as much pain as they are. There’s just this instant sense of relief of not being alone.”

Reed, 40, had pursued massage therapist school around the same time they had begun presenting in “a much more gender-bending way.” They began practicing on friends and clients who identified as transgender or gender nonconforming. Over and over again, Reed heard people say they had never felt comfortable getting a massage since coming out as trans. Many of these clients also grappled with severe chronic pain.

It became very clear, Reed said, “that the trans community was being underserved despite desperate need, and that the people I was training with were not going to be the people who could serve them.”

After graduating from massage school and leaving a career in nonprofit management, Reed opened Freed Bodyworks seven years ago. The clients immediately started pouring in, Reed said. “As soon as there was somebody to go to, I had a waiting list out the door.”

The company has since expanded to 23 practitioners offering holistic services around a mission of inclusivity of all bodies and gender identities. It offers LGBTQ-friendly massages, counseling and classes such as “Mindful Curves,” a yoga class for larger bodies. Each year, Freed Bodyworks sees more than 6,000 clients — about 30 percent of whom identify as transgender or gender-nonconforming, said Reed, who now co-owns the business with their partner, Jessica VonDyke.

The demand for its services continues to grow, particularly as more insurance companies have begun covering transition surgeries and access to hormones, Reed said. The wellness center has also seen a notable surge in clients within the past two years, which Reed believes may be attributed to added stress members of the LGBTQ community have felt under the Trump administration.

Connor Cory first started getting massages from Freed Bodyworks a few years ago, when he had just started law school and had recently begun openly identifying as a transgender man. Through one-on-one massages and group binding classes, Cory has learned how to mitigate extreme back pain and poor alignment after years of binding, he said. Massage therapists at Freed Bodyworks have also helped him loosen up scar tissue from undergoing chest surgery about two years ago.

“You’re used to having to advocate for yourself at every turn,” Cory said. “Going to a place like Freed Bodyworks, where you’re sort of treated as the norm . . . I don’t know of any other place like that.”

Reed has seen clients who have traveled from rural areas hours away. Some don’t have the resources to pursue top surgery in their communities and rely on binding for up to 12 hours a day to “pass” in their places of work, in industries such as construction. Reed described another client, a 17-year-old, who suffered such excruciating rib pain from binding that he sometimes had to go home from high school.

Minimal research has been conducted on the health impacts of binding. But one study published in 2016, the Binding Health Project, found that physical discomfort was almost universal among transgender adults who bind. The vast majority interviewed said they had experienced a negative health outcome, including back pain, overheating, chest pain, shortness of breath, itching and bad posture.

However, participants frequently reported that the advantages of binding far outweighed the drawbacks, saying it significantly lessened their anxiety, depression and suicidal feelings, and made them feel safer and more confident.

It wasn’t until after Reed had started teaching binding classes that the practice took a toll on their own life. After working as a massage therapist in a binder every day for years, Reed developed such a severe shoulder injury that they were unable to lift their right arm and were forced to take five months off work as a massage therapist.

“I couldn’t wear a binder at all for those five months. I couldn’t even wear a traditional bra because the pain was so severe,” Reed said. “The gender dysphoria that caused for me was huge.”

Reed starts each class by sharing this story, and teaching students how to mitigate pain and prevent injuries of their own. They urge students to spend a few minutes a day going through self-massaging techniques. Reed demonstrates how to massage their diaphragm muscle tissue near the edge of the binder and how to roll a tennis ball against their trapezius muscle using a corner of a wall. In another technique, Reed lies down on a roller and extends their arms toward the floor, opening their chest.

Written on the wall overlooking the class is a quote from Leslie Feinberg, a transgender rights activist who died in 2014, a few months before Freed Bodyworks moved into its current building.

“I felt as though I was rushing into a burning building to discover the ideas I needed for my own life,” the quote reads.

It’s a message that informs not only the class, but also the rest of Reed’s work, the massage therapist said.

“People are desperate for help at the level of rushing into a burning building,” Reed said. “They’re looking for the tools that are going to be able to support their ability to live their best life, on their terms.”