Knowledge Database

Horse riding as Therapy

Angela Levine - Volunteer, Beit Issie Shapiro


The healing potential of horses have been recognized for thousands of years. The concept of horses being partnered with humans in a therapeutic capacity was noted in ‘Natural Exercise’, a text written between 460-375 BCE by Hippocrates, the Greek physician and philosopher. The benefits of horse riding were also extolled by European physicians and therapists from medieval times onwards.


The modern-day impetus for equine healing therapies is credited to the achievements of Lis Hartel, a horse-loving Danish woman who contracted polio at a young age. Paralyzed from the waist down, and with little feeling left in her arms and hands, she nevertheless became the first woman to ride for an Olympic Equestrian Team, and the first to win medals at both the 1952 and 1956 Olympic Games. Together with her therapist, Hartel opened the first Therapeutic Riding Center in Europe. Centers throughout Europe and the USA followed, with physical therapists eventually using horses to treat a wide range of physical and neurological disabilities. (Jackson, 2014)


The logic behind the use of the horses for therapeutic purposes lies in the fact that the way they move simulates the gait of humans. The horse’s stride moves the rider’s pelvis with the same rotation and side-to-side movements that resemble the movement of people without disabilities. ((Lessick, et al, 2004) It is this natural physiological response elicited in the rider that is used in equine therapy to promote strength, balance, coordination, flexibility and confidence. (Borzo,  2002).


Therapy of any kind is hard work, especially for children with disabilities who may have to participate in several types of therapy on a regular basis without understanding their goal. As a result, they may offer resistance to performing tasks that challenge them. However, being around horses is different. The children have fun out in the fresh air, while simultaneously participating in a therapeutic session.


The horses used for therapy are specially trained and selected to match the needs of the rider. For instance, people with weak trunk control may at first be seated on a slow moving horse until they become strong enough to be challenged further. Those with muscular degeneration need a livelier horse and greater movement to stimulate their muscles.  ( Lessick, M., Shinaver, R., et alia (2004) .

There are two types of equine-based therapy: Therapeutic Horseback riding therapy and Hippotherapy (Hippo – the Greek word for horse); although distinctions between the two are not always made clear in literature on the subject.


Therapeutic horseback riding (HBRT) is a team activity. Its aim is to teach people with special needs to ride a horse. It has secondary aims too, like improving physical abilities or increasing self- confidence. Sessions are directed by a trained riding instructor, together with assistants. The instructor is not a professional therapist, but is nevertheless well acquainted with the needs of the participants and the best ways to communicate with them.  


Once the riders have mastered the basics of riding and feel confident astride a horse, they may be asked to perform a variety of exercises aimed at improving posture and muscle strength. These exercises could be based on the ‘Developmental Riding Therapy’ set out in a book by Jan Spink (Spink, 1993].


For example, participants may be asked to lean over and touch the horses’ ears or tail, lie on its back with legs bent and then rise to a sitting position, throw beanbags into cans, or just imitate the arm and body movements of the instructor.  The fact that the riders are required to listen and respond to instructions, interact not only with the horse but also with other riders, makes for a multi-sensory and socially positive experience (Grandin et al., 2010).


In contrast, hippotherapy (HP) is an individualized form of treatment aimed to utilize horses to improve or correct a specific disability. Sessions are directed by an appropriate professional who may be an occupational, speech or physical therapist.  As in therapeutic riding, participants are accompanied by lead and/or side walkers to ensure their safety.  


Many research papers analysis the effects of hippotherapy or therapeutic riding on children with either cerebral palsy or autism (ASD).


Cerebral palsy (CP) is a term used to define a spectrum of postural and motor abnormalities that have resulted from injury to the developing nervous system. Additional consequences may include cognitive and sensory defects.  One of the major problems encountered by children with CP is defective postural control that can affect many aspects of their daily life.  


The effectiveness of equine-therapies to rehabilitate children with cerebral palsy is discussed in many articles. One of these is in the form of meta-analysis (Zadnikar, 2011.) 77 studies were located by searching through multiple online databases. Among them, only 10 met the methodological quality criteria set by the author, and a further two were since they did not include comparison groups.


There was a consensus opinion that support for the claim that all types of equine therapy improve the gross motor functioning of  children with CP. Specifically mentioned were posture, weight balance and co-contraction – that is the simultaneous activation of antagonist muscles around a joint , one muscle contracting while the other relaxes when a person is static or moving. 


Autism spectrum disorder is characterized by impairments that may include communication, social skills, cognitive and motor functioning.  These disabilities have the potential to affect a child’s volition – its inner drive or motivation to accomplish a task or to succeed in a specific situation.


Researchers at the University of Illinois (2009, Taylor, R; Smith C., et alia) investigated the effects of a hipppotherapy program on the volition of three children between the ages of 4 and 6.  This was a twice a week, 16 session program, with each intervention lasting 45-minutes. Videotaped data was collected and analyzed. The volition levels of the children were checked at the beginning, middle and end of the eight-week program using the Pediatric Volitional Questionnaire where motivation is assessed during a standardized play period and the participants rated according to a 4-point scale under the headings:  passive, hesitant, involved and spontaneous. 


The hippotherapy sessions were directed by a pediatric physical therapist who was also a trained hippotherapist. A wide belt – a surcingle - was wrapped round the girth of the horse and attached to a handle held by the rider. This device provided stability and enabled close contact between horse and rider. The sessions began with the horses walking in a clockwise and then in an anti-clockwise direction. Next, obstacles were placed in the path of the horse so that horse and rider had to weave between cones and poles. Posters were pasted on the walls of the arena. The therapist would refer to them, encouraging the riders to respond verbally to these images while they were riding.  


At the conclusion of this intervention, it was found that the volition of all three children was enhanced.  However, the team that carried out the study advocated that future research should include much larger numbers of children, as well as a control group. (Taylor et al, 2009). 


Another means of assessing the effects of equine-related therapy on children is to interview parents and listen to note their impressions. This angle of research was the subject of a MA thesis carried out under the auspices of Stellenbosch University, South Africa (Boyd, 2015) A number of parents out the 200 children attending therapeutic sessions at the Cape Town branch of the Association of Horseback Riding for the Disabled agreed to be interviewed.


The ages of their children ranged between 6 and 17 years of age, their disabilities were varied and included cerebral palsy, Down syndrome, mental and physical impairment. The interviews were audio-recorded, transcribed and analyzed.


Parents commented on improvements in posture, balance and walking abilities. Some of their children were very limp at first and struggled to hold themselves up on a horse, but during therapy, their posture and balance improved. Psychological effects were also noted. Like an increase in a sense of independence and pride in their achievements. Cognitive abilities were also enhanced. Some parents commented that their children were more focused and that their speech was clearer.  One mother told the interviewer that her autistic child’s interaction with a horse had enhanced the way she reacted with people.  Most of the people interviewed remarked that the sessions had a calming and relaxing effect of their children, especially those with hyperactive tendencies.


Many of the parents spoke of the enjoyment that their children obtained from riding and their joyful anticipation leading up to each session. The reason for the sense of joy felt by this group, and by any disabled person who participates in equine- based therapy, is simply the fact that, together with a sense of well-being, “it promotes the expansion of their world as opposed to shrinking it, which is a common occurrence for people with disabilities whose activities and choices in life are limited.” (All, et al., 1999). 





All, A. C., Loving, G. L., & Crane, L. L. (1999). Animals, horseback riding, and implications for rehabilitation therapy. Journal of Rehabilitation65(3), 49.


Borzo, G. (2002). Horsepower: When riding turns into treatment, American Hippotherapy Association, Inc. Retrieved November 12, 2017 from


Boyd, L. (2015). “When he’s up there he’s just happy and content”: parents’ perceptions of therapeutic horseback riding (Doctoral dissertation, Stellenbosch: Stellenbosch University).


EdDy, A. H. F., & Bowers, C. M. (2010). The use of therapy animals with individuals with autism spectrum disorders. Handbook on animal-assisted therapy: Theoretical foundations and guidelines for practice, 247.


Jackson, L. (2014). Olympic Girl Power, the Incredible story of Liz Hartel, Horse Nation, Retrieved  November 12, 2017, from


 Lessick, M., Shinaver, R., Post, K. M., Rivera, J. E., & Lemon, B. (2004). Therapeutic horseback riding. AWHONN lifelines8(1), 46-53.


Spink, J. (1993). Developmental riding therapy. Therapy Skill Builders.


Taylor, R. R., Kielhofner, G., Smith, C., Butler, S., Cahill, S. M., Ciukaj, M. D., & Gehman, M. (2009). Volitional change in children with autism: A single-case design study of the impact of hippotherapy on motivation. Occupational Therapy in Mental Health25(2), 192-200.


Zadnikar, M., & Kastrin, A. (2011). Effects of hippotherapy and therapeutic horseback riding on postural control or balance in children with cerebral palsy: a meta‐analysis. Developmental medicine & child neurology53(8), 684-691.

  • Disabilities:

    All disabilities

  • Topics:

    Therapeutic Methods

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