• Complementary and Alternative Medicine

Understanding Hippotherapy: Healing Through Horseback Riding

Medically reviewed and edited by Maria Ablao APRN, FNP-C

What is Hippotherapy?

Hippotherapy refers to a specific form of physical, occupational, and speech therapy. It gets its name from the ancient Greek 'hippos,' meaning 'horse,' and 'therapy,' meaning 'treatment.'

During hippotherapy, therapists use the characteristic movements of a horse to provide motor and sensory input. By engaging in activities on the horse that are enjoyable and challenging, patients improve core strength, balance, coordination, and posture.

Hippotherapy  is beneficial for conditions like cerebral palsy, autism, and multiple sclerosis. It also enhances cognitive processing and emotional well-being.

History of hippotherapy

Since the time of the Ancient Greeks, people have recognized the connection between horseback riding and its effects on the body.

It wasn’t until the 1960s, though, that horseback riding started to be used as a complementary aid to physical therapy. 

In 1992, the American Hippotherapy Association (AHA) was founded. Since then, hippotherapy evolved into a therapeutic method that combines various elements with other therapies – such as occupational therapy, speech therapy, and cognitive behavioral therapy. 

With technological advancements, hippotherapy simulator equipment was introduced. This innovation expanded the scope of practice for hypnotherapists, enabling them to conduct sessions from any location – and without the need for actual horses.

Hippotherapy vs. Therapeutic Horseback Riding

While hippotherapy and therapeutic horseback riding both use horses for therapeutic purposes, their primary goals are different.

Hippotherapy is more focused on using the horse's movement as a specific therapeutic tool under the guidance of a licensed therapist, whereas therapeutic horseback riding emphasizes riding skills and recreation.

How Does Hippotherapy Work?

Hippotherapy offers effective sensory stimulation for riders through the horse's variable, rhythmic, and repetitive movements. These movements mimic the natural motion of the human pelvis during walking and encourage the patient to achieve proper balance and posture. They also provide a large spectrum of sensory and motor input. 

Patients respond to this engaging treatment with greater compliance and enthusiasm, improving balance, mobility, and posture. Hippotherapy also shortens recovery times from injuries and strokes – promoting motor recovery and enhancing patients' balance and muscle control. 

What are the Two Types of Hippotherapy?

Hippotherapy can be utilized in two ways: riding real horses or using simulators. 

Real Horses 

This type of hippotherapy uses real horses and incorporates a range of activities, from riding the horse to leading it. It’s conducted by a trained team consisting of the horse, the therapist, and one or two side walkers. 

Before the sessions, horses are screened for temperament and movement quality. Therapists must be attentive, as clients may experience anxiety or fear while riding. 

Simulators

With simulated hippotherapy, simulator equipment is used to mimic the horse riding experience. Safety measures are in place to ensure the patient’s comfort and security throughout the session. Just like hippotherapy with real horses, the therapist and possibly side walkers are present to assist and support as needed.

A session like this begins with the patient being positioned on a specialized hippotherapy simulator with various gaits and movements that are typical of horse riding, such as walking, trotting, and cantering. This helps engage the patient’s muscles and balance.

A trained therapist guides the patient through exercises and movements to achieve their therapeutic goals. The therapist may adjust the simulator settings to customize the experience based on the patient's needs.

Over time, patients can expect to experience physical benefits such as improved core strength, balance, coordination, and posture. The rhythmic movements of the simulator can also have calming effects, helping to reduce stress and anxiety.

Sessions often include interactive elements where patients may engage in games, exercises, or tasks to further enhance therapeutic outcomes.

Benefits of Hippotherapy

Physical benefits

Hippotherapy isn't merely recreational horseback riding; it's a structured therapeutic intervention designed to harness the physical benefits of horse movement in a controlled environment. 

During hippotherapy sessions, participants not only work on physical fitness but also experience a unique form of therapy that addresses specific motor challenges through targeted exercises and interactions with the horse.

The horse's rhythmic movements require constant engagement of core muscles to maintain balance and stability. This continual activation helps strengthen and tone core muscles, including those in the abdomen and back, while also enhancing overall muscle flexibility and strength. In addition, the three-dimensional movement of the horse's pelvis closely mimics human walking patterns, which can improve joint mobility and refine postural control.

These physical improvements are particularly beneficial where enhancing motor skills and coordination is crucial, especially for individuals managing conditions such as:

• Cerebral palsy

• Autism spectrum disorders

• Multiple sclerosis (MS)

Cognitive benefits

During hippotherapy sessions, riders must concentrate on coordinating their movements with the horse's actions, following instructions from the therapist or instructor, and adapting to changing situations during sessions. 

This dual focus on physical control and cognitive engagement improves cognitive processing abilities. This is especially important for individuals with developmental delays or cognitive impairments. 

Additionally, navigating the space around the riding arena and interacting with the horse and therapists promotes spatial awareness and sensory integration, further enhancing cognitive development.

Emotional and psychological benefits 

Hippotherapy creates a nurturing environment where riders can build confidence, self-esteem, and emotional resilience. Successfully mastering riding skills and accomplishing therapeutic goals with the support of trained professionals creates a sense of achievement and empowerment. 

The calming effect of the horse's movements also helps reduce anxiety and stress levels, promoting emotional regulation and relaxation. Also, the social aspect of hippotherapy — interacting with therapists, instructors, volunteers, and other riders — encourages socialization skills and establishes meaningful connections, contributing to overall emotional well-being. 

Who Can Benefit from Hippotherapy?

Individuals with autism

Children with autism spectrum disorder often find therapeutic horseback riding to be particularly beneficial. The rhythmic movements of the horse can help improve sensory processing, promote relaxation, and enhance social interactions.

Individuals with cerebral palsy 

The dynamic movements of the horse stimulate muscles and joints. This helps to improve muscle tone, increase balance, and enhance coordination. 

For example, children with cerebral palsy have shown enhanced trunk stability and improved walking patterns after participating in hippotherapy sessions. 

These physical gains translated into greater independence in daily activities, demonstrating the functional benefits of hippotherapy in improving mobility and quality of life.

People recovering from stroke

The controlled yet dynamic nature of horse movement can aid in restoring motor function, improving posture, and regaining confidence in movement. Research highlights that hippotherapy sessions help patients with stroke improve strength, balance, and gait. 

Individuals with special educational needs and severe emotional trauma

A case study emphasizes hippotherapy's multifaceted therapeutic benefits — integrating physical, emotional, cognitive, and social dimensions — to support comprehensive rehabilitation in individuals with complex emotional stress and trauma backgrounds.

During hippotherapy, significant improvements are observed in postural rehabilitation –  including neck positioning and thoracic kyphosis (excessive curvature in the spine that leads to a rounded upper back) – addressing physical manifestations of trauma. 

During the study, individuals showed unexpected emotional responses like smiling during tasks, challenging initial diagnoses of "Blunted Affect" (expressing emotions through facial expressions), and suggesting improvements in affective responses and emotional regulation. 

The findings emphasize hippotherapy's multifaceted therapeutic benefits, integrating physical, emotional, cognitive, and social dimensions to support rehabilitation in individuals with complex emotional stress and trauma backgrounds.

Important Considerations

Safety 

Safety is paramount in hippotherapy, ensuring both the well-being of participants and the effectiveness of the therapy. 

Qualified therapists play a crucial role in ensuring safety during hippotherapy sessions. They should have specific training and certification in hippotherapy techniques and hold licenses in occupational therapy, physical therapy, and/or speech-language pathology. 

Additionally, horses chosen for hippotherapy must possess a calm temperament, consistent gait, and reliability to ensure a stable and predictable experience for riders.

Accessibility and cost

Hippotherapy programs may vary in availability depending on location and resources. While some programs may be covered by insurance or funded through grants, others may require out-of-pocket expenses.

To find certified hippotherapy programs, individuals can consult with healthcare providers, local therapy clinics, or organizations such as the American Hippotherapy Association (AHA). 

The AHA provides resources and maintains a directory of certified therapists and centers offering hippotherapy across the United States, ensuring access to qualified professionals and safe environments for therapeutic horseback riding experiences.

How Can LifeMD Help?

While LifeMD does not offer hippotherapy – as this therapy can only be offered in person – a team of licensed healthcare professionals is available to assist with a variety of other healthcare needs.

Make an online appointment to get started.

Maria Ablao APRN, FNP-C

Maria, an experienced healthcare professional with over a decade in nursing, advanced to a Family Nurse Practitioner in 2020. Prioritizing prevention and holistic care, Maria emphasizes compassion and adopts a family-centered approach to providing care. Her passion for health and wellness is evident through her commitment to exercise and clean eating, serving as an example to others. Maria advocates for education and improving quality of life in conjunction with treatment.

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