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Therapeutic Horseback Riding – An Overview

Therapeutic Horseback Riding – An Overview

Therapeutic Horseback Riding (THR) is a therapeutic program that provides equine assisted activities for individuals with disabilities in order to improve their physical, emotional, and mental well-being. This is done through an adaptive riding program that focuses not only on riding skills but also on the development of a relationship between the horse and rider. The program can include work both on the ground such as grooming, leading, or directing a horse, and activities on horseback.

Therapeutic riding activities are conducted by certified therapeutic riding instructors in conjunction with trained volunteers. During riding activities a new rider or an individual with physical limitations is generality assisted by two side-walkers who walk alongside the horse, as well as a horse leader. These individuals are volunteers that have been trained to assist the instructor in the conduct of the therapeutic program.

Therapeutic riding differs from hippo-therapy, one form of equine assisted therapy, in that in hippo-therapy a physical or occupational therapist uses only the movement of the horse to improve an individual’s sensory and motor skills. The therapist does not teach riding skills or seek to develop a relationship between the horse and rider. The primary goal of hippo-therapy is to improve the individual’s balance, posture, function, and mobility. Therapeutic riding is a broader program of therapy that can include multiple therapeutic elements simultaneously.

Therapeutic riding combines the physical aspect of riding in improving balance, posture and mobility and adds the mental, emotional and cognitive skills required to ride a horse and develop a positive working relationship with the horse. This expansion of therapy beyond just the physical aspects involved in riding a horse can improve an individual’s emotional control, behavioral self-regulation and cognitive functioning and help them function more productively and effectively in society.

Therapeutic riding centers and their instructors are certified by the Professional Association of Therapeutic Horsemanship International and therapy is conducted as part of an overall treatment plan developed in conjunction with a medical health professional. Safety is a paramount concern and therapeutic riding is not appropriate for individuals with certain disabilities. Instructors work with the health care provider to plan for the individual’s needs, appropriate supervision, and ensure rider safety.

There are a wide range of physical, mental, and emotional disabilities that can benefit from the use of therapeutic riding. Some of the many individuals who research has proven can benefit from therapeutic horseback riding include those with attention deficit disorder, autism, amputations, brain injuries, stroke, cerebral palsy, downs syndrome, multiple sclerosis, spinal cord injuries, and a wide variety of emotional, cognitive, or mental disabilities.

For those with physical limitations experiencing the rhythmic motion of a horse can be very beneficial to improve muscle function and control. Riding a horse moves the rider’s body in a manner similar to the human gait, so riders with physical needs often show improvement in flexibility, balance and muscle strength. For individuals with mental and emotional challenges, the unique relationship formed with the horse can lead to increased confidence, patience and self-esteem

There have been numerous studies that have shown evidence of the benefits of therapeutic riding. Individuals with cognitive disabilities such as autism or Downs Syndrome have shown demonstrated benefits from THR. Bass, Duchowny, and Llabre (2008) found that children with autism who participated in a therapeutic horseback riding program improved in sensory integration and directed attention as compared to the control group. While Biery and Kaufman (1989) showed that significant improvement was seen on standing and quadruped balance after the therapeutic riding program for individuals with Downs Syndrome

A large amount of research in therapeutic riding has involved children with cerebral palsy as therapeutic riding has long been used as a method to help improve their physical abilities. Zadnikar and Kastrin (2011) conducted an analysis of multiple studies on the effectiveness of THR for children with cerebral palsy. It was found that riding lead to improved coordination, head and trunk control and improved gait. There are several reasons posited for these improvements. One is that the horse’s gait provides a precise, smooth, rhythmic, and repetitive pattern of movement to the rider that is similar to the mechanics of human gait. Another reason is the horse’s center of gravity is displaced three-dimensionally when walking, resulting in a movement that is very similar to that of the human pelvis during walking. A final reason for the physical benefits is that adjusting to the horse’s movements involves the use of muscles and joint movements which, over time, lead to increased strength and range of motion. Although these studies were focused on individuals with cerebral palsy, it is believed the physical benefits would also apply individuals with other types of physical disabilities as well.

Therapeutic riding can be a great source of exercise and therapy for people with multiple sclerosis. They can participate in riding within their limits of strength and energy and still enjoy an active recreational activity. Much like individuals with cerebral palsy it can also help improve an individuals physical motor skills and help them stay limber and active. Silkwood-Sherer and Warmbier (2007) found that individuals demonstrated a statistically significant improvement in balance following 7 weeks of therapeutic riding.

In looking at children with learning disabilities, Crothers (1994) theorized that riding a horse stimulates both hemispheres of the brain simultaneously to improve their cognitive abilities. It is also thought that the areas of the brain that control attention, impulses, and activity levels are directly stimulated. As energy is directed to different parts of the brain, and attention is called to many separate tasks at once (picture holding the reins, balancing, and directing the horse, all while completing a task), the neurotransmitters released when riding create an effect that is similar to the one created by stimulant medication that is normally prescribed for children with ADHD. This then makes it possible for an ADHD child to concentrate and to be less hyperactive, fidgety, or impulsive.

Therapeutic riding has gained increasing use to treat posttraumatic stress disorder, depression, and other mental illness with many organizations, including the Veterans Administration, establishing programs for veterans. These programs have proven extremely popular and anecdotally have shown great success. However, there has been no significant completed research on these veterans programs. Shambo and Seely (2010) conducted a study to measure specific changes and durability of change for adult women with PTSD and Borderline Personality Disorder who were victims of traumatic interpersonal violence, when treated with therapeutic riding. In this study, individuals showed significant positive changes in depression, dissociative symptoms, and treatment effectiveness overall. The change effect continued post treatment as participants’ scores showed even more improvement in follow ups four month later. It is believed that ongoing research into the effectiveness of veterans and other mental health aspects of therapeutic riding programs will show similar benefits.

Therapeutic riding also has benefits that are not always directly measurable, but are seen in the perceptions of others who interact with individuals. Miller and Alson (2004) studied the benefits that therapeutic riding has on children with disabilities through the eyes of their parents. The results indicated that the parent noted significant changes in their children who are in these types of programs including increases in self-esteem, following directions to the fullest, and better socialization skills.

Viewing the equine as a partner provides opportunities for relationship building and interpersonal skill development with all individuals who participate in therapeutic riding activities. Because of this potential emotional benefit, recent research studies have looked into the impact of therapeutic riding with a variety of populations. Kaiser, Smith, Heleski, and Spence (2006) used an 8-week therapeutic riding program, to demonstrate decreases in anger in adolescent males. Additionally, the mothers’ perceptions of their sons’ behaviors improved. Another study found statistically significant improvements in self-concept, intellectual and school status, popularity, happiness, and satisfaction in emotionally and behaviorally challenged teens (Emory, 1992).

To maintain therapeutic standards the Professional Association of Therapeutic Horsemanship International (PATH Intl.) is the primary organization for the certification of therapeutic riding centers and instructors. The organization establishes and maintains standards to promote safety and achieve optimal outcomes for individuals in equine assisted therapies. It is focused on the establishment of industry guidelines for the practice and teaching of therapeutic riding to ensure that centers and instructors maintain the safest, most ethical and most effective programs possible. There are over 4,600 certified PATH instructors and 850 PATH centers worldwide that provide therapeutic riding and other equine assisted activities and therapy.

To become a PATH certified riding instructor an individual must successfully complete a skills assessment and certification exam, complete 25 mentored instruction hours conducting classes with a certified PATH professional, and complete an on-site certification event. The certification event is the candidate’s final evaluation. Typically a two day event, it is divided into two categories; horsemanship and teaching ability. An individual has two years to complete all of the requirements to obtain certification once they start the certification process.

Once an individual obtains their certification they must document a minimum of 20 hours of continuing education annually, of which at least 6 hours must be disability education. Disability education is designed to provide instructors with greater understanding of the physical, social, cognitive and/or behavioral impacts experienced by individuals with disabilities, mental health disorders or emotional trauma. The education should help the instructor understand how to communicate with and more effectively instruct a wide range participants. Beyond the basic certification level, individuals can obtain advanced and master riding instructor certification through demonstrating increasing levels of skill and experience through an extremely rigorous certification process.

The certification requirements work to insure that therapeutic programs provide a safe and beneficial environment for the riders, volunteers, and the horses involved in the program. The amount of benefit gained through therapeutic riding differs from person to person based on many factors such as the type of disability, severity of disability, motivation of the rider and connection between horse and rider. Unlike exercise machines that may only focus on one muscle group at a time and do not use natural body movements, riding forces the rider to make use of the entire body to steer, control, adjust the horse and maintain balance. Because horses require not only physical skill but also cognitive skill for achievement, riding reveals the strengths and weaknesses of the rider. During traditional therapeutic techniques patients often reach a plateau where they may lose motivation. However, the pleasure and excitement of riding can provide additional motivation to encourage patients to work through their pain and discomfort. The act of accomplishing something that even able-bodied people are sometimes afraid to try can also sometimes benefit those with disabilities, providing them with additional confidence and self-esteem.

It is clear from the research and from the responses of individual participants that therapeutic riding is a physical activity that can provide significant benefits to individuals with physical, emotional, or mental challenges. It requires an individual to control and exercise a wide range of muscles, while simultaneously having the individual exercise emotional and cognitive skills required to maintain control of the horse. Like any physical activity it provides benefits beyond those to the muscular skeletal and cardiovascular systems. There are boosts to cognitive skills as well as to emotional well-being. The interaction with the horse adds an additional element to the equation in that the individual can establish a relationship or connection with their equine partner. Therapeutic riding is a beneficial physical activity has demonstrated the ability to change and benefit the lives of numerous individuals and assist them to live a healthier, more active, and more productive life.


Biery, Martha, Kaufmann, Nancy, 1989, “The Effects of Therapeutic Horseback Riding on Balance.” Adaptive Physical Activity Quarterly, Volume 6, Issue 3, pgs 221-229.

Crothers, G. (1994). “Learning disability: Riding to success.” Nursing Standard, 8, 16-18.

Emory, D. (1992). “Effects of therapeutic horsemanship on the self-concepts and behavior of asocial adolescents.” Dissertation Abstracts International, DAI-B 53/05, 561.

Kaiser, L., Smith, K., Heleski, C., & Spence, L. (2006). “Effects of a therapeutic riding program on at-risk and special needs children.” Journal of the American Veterinary Medical Association, 228, 46-52.

Learn About Therapeutic Riding. PATH International, November 3, 2015.

Miller, John, Alston, Dr. Antoine J, “Therapeutic Riding: An Educational Tool for Children with Disabilities as Viewed by Parents”, Journal of Southern Agricultural Education Research, 2004, Volume 54, Number 1, pgs 113-123.

Scheidhacker, M., Bender, W., and Vaitel, P. (1991). “The effectiveness of therapeutic horseback riding in the treatment of chronic schizophrenic patients. Experimental results and clinical experiences.” Nervenarzt, 62, 283-287.

Shambo, Leigh, Seely, Susan K., Voderfecht, Heather R. “A Pilot Study on Equine Facilitated Psychotherapy for Trauma Related Disorders”, 2010,

Stickney, Margaret Ann, “A Qualitative Study of the Perceived Health Benefits of a Therapeutic Riding Program for Children with Autism Spectrum Disorders”, 2010, University of Kentucky Doctoral Dissertations. Paper 40.

Zadnikar Monika, Kastrin Andrej, “Effects of hippotherapy and therapeutic horseback riding on postural control or balance in children with cerebral palsy: a meta-analysis”, August 2011, Developmental Medicine & Child Neurology, Volume 53, Issue 8, pages 684-691.