What are hippotherapy and therapeutic riding (THR)?

horse-1For children with special needs, horseback riding may be very therapeutic. It may help your child improve socially, cognitively, behaviorally, physically and emotionally. And, to top it off, it can be loads of fun!

Hippo is the Greek word for horse. Hippotherapy and therapeutic riding (THR) are terms that are commonly used interchangeably to describe therapy that is provided with the help of a horse. But, there are some differences between the two.

What is hippotherapy?

The motion of the horse as it walks provides sensory input to the child. The horse’s movement is rhythmic and repetitive and closely resembles the normal gait (walk pattern) of a person. This sensory input movement is thought to help your child feel and learn the motion that is needed to learn to walk. Usually a licensed professional therapist provides OT, PT or ST as the child is on the horse. A child may even do certain exercises while lying down on the horse. In essence, it is therapy given while on a horse. The horse handlers are responsible for controlling the horse. Your child is not learning how to independently ride a horse in hippotherapy.

What is therapeutic riding (THR)?

Therapeutic riding is different from hippotherapy because THR focuses on riding skills and therapeutic activities. For instance, special tasks are given to your child to work towards certain goals (such as learning how to steer the horse, learning right from left, communicating with the horse handlers or “side walkers,” etc.). Your child slowly learns specific riding skills. Your child may or may not be in primary control of the horse depending on his level of skill and expertise.

Whatever the differences, the similarities are clear in that the use of a horse is key in working towards achieving functional goals.

What is it like?

When my daughter was younger, I took her to therapeutic riding sessions once a week. She sat on the horse and needed to sit up straight, hold the reins and pull on them to make the horse go in a certain direction. She needed to give walking commands to the horse (“Walk on Toby”) and listen to the instructors by her side. At first I was nervous as my little one sat atop this huge horse – she was speech delayed and often needed more time to process what was said to her. Her muscle tone was relaxed so working on her posture was not an easy task. But, I sat on the sidelines and watched quietly.

In time, I saw my daughter become more confident in her speech and movements as she directed the horse to move ahead, slow down or stop. Her posture improved as the sessions became more complicated – such as reaching for hoops or picking up objects alongside the rink while she kept the horse moving forward. She had conversations with her horse “side walkers” and formed a special bond with the horse, Toby.

My niece, who has autism, absolutely loves her riding sessions. Her ability to understand verbal commands has improved considerably since starting her therapy. She shows a sense of confidence and excitement when she arrives at the stable that she does not show in other environments. It is hugely evident from the smile on her face that she is thoroughly enjoying herself. She also displays a level of patience and control while on the horse that is not seen in other circumstances.

Where can you find hippotherapy or THR?

To learn more about hippotherapy, contact the American Hippotherapy Association. Click on “find a facility” in their drop down menu to locate a stable near you. The AHA maintains hippotherapy standards for programs and professionals.

To learn more about therapeutic riding, contact the Professional Association of Therapeutic Horsemanship International (PATH Int’l). Click on “find a center” to locate a stable near you. PATH establishes the industry standards for program safety as well as instructor training and certification.

Usually, a program accepts children as young as 4 years of age but rules may vary from one organization to another. Likewise, the cost of a program varies widely, although many organizations offer financial assistance. Be prepared to encounter a waitlist as these programs are usually immensely popular.

Is hippotherapy or therapeutic riding medically beneficial?

There aren’t a lot of robust studies, but I took a look at some of the more recent research as it pertains to children with developmental delays, autism and cerebral palsy (CP).

One study found that therapeutic riding may lead to improvement in gross motor function in developmentally delayed children “and that these improvements remain once therapeutic riding ceases.” Another study found that children with autism had improved behaviors (such as social motivation and less inattention, distractibility and sedentary behaviors). A review of 8 studies found that “riding therapy is indicated to improve postural control and balance in children with CP,” while another review found that both hippotherapy and THR have positive effects on gross motor function on children with CP. But, there are also studies that did not show definite results. Some had sample sizes that were too small to draw conclusions, or simply did not find any benefits for kids with CP.

Bottom line

More studies are needed to back up the benefits to which many parents, clinicians and even the patients themselves attest. But, aside from the studies, it may be worth it to look into any therapy that might benefit your special needs child. What works well for one child may not help another, and vice versa. Often you have to try more than one therapy to see what helps your child. And, often it is a combination of therapies that helps a child take off and make progress.

Have you tried any kind of horseback riding therapy for your child? Please tell us about your experiences.

Note: This post is part of the weekly series Delays and disabilities – how to get help for your child. It was started on January 16, 2013 and appears every Wednesday. Go to News Moms Need and click on “Help for your child” on the menu on the right side to view all of the blog posts to date. As always, we welcome your comments and input.


  • comment-avatar

    Nice work at defining both hippotherapy and therapeutic/adaptive riding. It is very helpful to define both services to help families understand the difference between them. Hippotherapy is a therapy/medical service and therapeutic/adaptive riding is a recreational/educational service. Both are great services and both have benefits. Children as young as two years old may participate in hippotherapy, while children need to be four years and older to participate in therapeutic/adaptive riding according to PATH guidelines. In addition, there are several peer-reviewed and published studies available on hippotherapy (OT, PT and Speech therapy) that the citation can be found at the American Hippotherapy Association website. Great article.

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    Barbara July 9, 2013

    Hi Gina. Thanks so much for your comment and for sharing info. The AHA is a great place to go for anyone interested in reading about studies on this topic. Thanks for visiting NMN.

  • comment-avatar
    Carolyn July 13, 2013

    This is a great and informative post. My son does hippotherapy and it has been great, thanks for sharing!

  • comment-avatar
    Barbara July 15, 2013

    Hi Carolyn,
    Thanks for your message! So glad you are finding hippotherapy helpful for your son.
    March of Dimes

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    John Sculley July 25, 2014

    Thank you for writing about the difference between Hippotherapy and THR. This post has great information. Hippotherapy also addresses a number of other conditions and the list is growing.