Hippotherapy, derived from the Greek word ‘hippos’, meaning horse, is a form of physical therapy for children and adults that uses the motion of a walking horse to provide therapeutic movement to the rider. It is a treatment that is used to bring about change in children and adults, in areas including balance, strength, sitting posture or sensory deficits. But what should you know about this unique style of therapy?
Who Can Benefit From Hippotherapy?
Hippotherapy can be beneficial for adults and children with special needs, from tiny tots to OAPs. If being mounted on the horse is not possible, working from the ground offers many opportunities to work on targeted functional activities to achieve the desired outcome.
As with all treatment modalities there are a few contraindications which might arise at assessment, but hippotherapy can have a positive effect on a wide variety of conditions. Everything from neurological to musculoskeletal, developmental delay to degenerative conditions, genetic or acquired, there is an increasing amount of clinical evidence now available in support of the positive impact that the horse can have in rehabilitation and functional improvement, impacting on both the physical and mental well-being of an individual.
How Does Hippotherapy Work?
During hippotherapy, the repetitive, rhythmical gait of the horse stimulates automatic responses from the client. This results in the mobilisation of joints and soft tissues, stimulation of joint receptors and the vestibular apparatus and challenges the balance of the client, whilst strengthening and re-educating weak or misused muscle groups.
Just as during land-based therapies, a variety of positions can be used on the horse in hippotherapy, with a secured back pad favoured over a traditional saddle, in order to maximise the transfer of movement and warmth from horse to client and facilitate changes in position.
Supine and prone lying along the horse’s back or across the barrel can be used in the early developmental stages, such as gaining head control and development of symmetrical posture. By using the shape of the horse, tonal patterns of movement can be influenced. Prone lying with a forearm prop can be progressed to forward lean sitting facing the rear of the horse, with weight bearing through the upper limbs onto the rump. Games and activities can be introduced to further encourage mobile weight bearing, influence tone and develop upper limb function.
Whilst sitting astride the horse, the client experiences the full impact of the three-dimensional movement of the horse’s pelvis that mimics that of the human pelvis during walking, moving forwards and backwards, side to side and rotationally.
Sideways sitting can be used to encourage lateral tilting of the pelvis and offers an alternative position for working on upper limb activities, challenging balance, and weight transfer. Four-point kneeling on the horse’s back mimics the movement pattern of crawling, and this can even progress to high kneeling or standing with small children, enabling them to experience the symmetrical walking pattern transferred from the horse.
Why Use A Horse or Pony?
A horse has a similar pace to a man taking approximately 100 strides a minute, resulting in approximately 2000 movements in a 20-minute therapy session. Each movement of the horse elicits an automatic response from the client to maintain their position. The stride length, pace and cadence of the horse’s gait can be manipulated by the horse handler. Along with changes in the direction of travel, combining turns and circles, and transitioning between walk and halt, the intensity of demand on the client and the desired response can be optimised to achieve the desired outcome.
Horses also offer a multi-sensory experience of soft fur and a coarse mane and tail to touch, relaxing warmth from the horse, soothing sounds of the horse breathing and the rhythmical steps, the sights and smells of an open airy environment and a view from a different height. Being introduced to a new, furry best friend, who accepts you as you are, makes no judgments and is always pleased to see you also helps to build self confidence. Although large, this friend is gentle and kind, very forgiving and somehow seems to understand the need to be calm and quiet with the smallest and most sensitive of clients. The best bit about hippotherapy is that it is therapy that is FUN. Therapists typically find that clients engage and do not even realise that they are doing their therapy.
Hippotherapy Therapists - What You Should Know
Following assessment of the client and goal setting, hippotherapy sessions are carried out by a suitably qualified therapist. In the UK, the majority of practitioners of hippotherapy are physiotherapists. However, there is growing interest amongst other therapists, resulting in the more specific terminology of equine facilitated physiotherapy, equine facilitated occupational therapy and equine facilitated speech and language therapy. In all cases, recognised postgraduate qualification is required before a therapist can commence working in this highly specialised area.
The Horse and Other Members of the Therapy Team
A horse must also undergo intensive training following assessment for its suitability for hippotherapy. Selected for its temperament, body structure and gait pattern, the horse must also be able to tolerate the changes of therapeutic position, and possible asymmetry and lack of balance of the client.
It must be willing to tolerate side walkers close to on either side and close behind, in order to observe the client’s responses and monitor alignment, or to encourage activities such as reaching for toys. During sessions, the horse will always be led by an experienced horse handler, and specially trained side-walkers will accompany the therapist to assist with changes of position of the client on the horse, to carry out targeted training activities, and to ensure the safety of the client, horse, and helpers. Each horse and client are carefully matched to achieve the best results.
How to get involved as a therapist?
Many therapists first encounter the benefits of being around horses and start their journey into hippotherapy by helping at Riding for the Disabled Association (RDA) sessions, where both the physical and mental benefits are acknowledged. Whilst some therapists run their hippotherapy sessions from their own premises or commercial riding schools, some will continue to develop their link by using RDA facilities and support staff, with the horse handler and side-walkers often being RDA volunteers. Riding skills are not taught in hippotherapy, although elements of riding skills may be incorporated especially if progressing to recreational riding is a goal of the client.
- Kwon,J.Y.,2015. Effect of hippotherapy on gross motor function in children with cerebral palsy. A randomised control trial. The Journal of Altenative and Complementary Medecine,Vol21(1),15-21
- Moraes, A.G.,Copetti,F., Angelo,V.R.,Chiavoloni,L. & DeDavid,C., 2020. Hippotherapy on postural balance in the sitting position of children with cerebral palsy - Longitudinal study. Physiotherapy Theory and Practice.Vol36 (2),259-266
- Whalen, C.N. and Case-Smith, J., 2012. Therapeutic Effects of Horseback Riding Therapy on Gross Motor Function in Children with Cerebral Palsy: A Systematic Review. Physical and Occupational Therapy in Pediatrics,32(3),229-242
- Yeo SM, Lee JY, Shin HY, Seo YS, Kwon JY. (2019). Factors Influencing Motor Outcome of Hippotherapy in Children with Cerebral Palsy. Neuropediatrics.50:170-177.