It may sound counterintuitive, but a 2,000-pound animal can help you heal – spiritually, mentally, and physically. Referred to as “equine assisted therapy,” “hippotherapy,” “therapeutic riding,” or just plain “horse therapy,” the modality has been practiced since 1946. That’s when Denmark’s Liz Hartel was paralyzed as a result of polio, and – thanks to horse therapy – was able to regain use of her legs and go on to win the silver medal for dressage in the 1952 Olympic Games, held in Helsinki, Finland. Equine assisted therapy has since proven to be a life changing experience and treatment for a variety of physical, neurological, cognitive, and emotional conditions. In addition, riding a horse can strengthen, engage, awaken, and bring joy to those who take the opportunity to be in the majesty of these intuitive creatures.
Rarely taking the spotlight in traditional rehabilitation settings, hippotherapy consists of treatment sessions on horseback delivered by an occupational therapist, physical therapist, or speech pathologist. You can benefit from these programs even though your legs may not have the ability to mount, squeeze, or direct the horse. Just like a service dog, the horse accommodates for the rider’s weakness, while tapping into the individual’s strengths and abilities to create movement and connection that is unique to each rider.
Mechanisms for Healing
A horse’s gait is similar to the neuromuscular pathway stimulation that occurs with walking. It provides sensory input through movement, which is variable, rhythmic, and repetitive. The resulting movement responses in the rider can help build the pathways that lead to improvements in motor skills and even walking. If paralysis is permanent, the rider’s core strengthening, balance, and fine motor skills can all show signs of improvement.
Horseback riding can improve muscle strength, increased range of motion, increased metabolism, and improved posture. “Horseback riding, along with mimicking the sensation of walking, can help build muscles that may not or cannot be used otherwise,” says Nicole Budden, founder and director of Happy Trails Riding Center in West Linn, Oregon. “Psychological benefits include improved confidence and self-esteem, enhancing social relationships, and improving coping skills.”
As is the case with many alternative therapies, horse therapy was initially greeted with great skepticism by the medical community. Over time, its success and supporters have changed hearts and minds. “It may appear to have a recreational flavor, but hippotherapy holds immense promise of therapeutic benefit for a variety of conditions, when used in concert with other therapies,” says Stephen T. Glass, MD, child neurologist in Woodinville, Washington.
Mia shown at HeartsRiding.org on her WHILL Model M Power Wheelchair
Starting Where You Are
Beth Fox, operations manager for the National Sports Center for the Disabled (NSCD), emphasizes the importance of working with each rider’s ability level. “If someone has CP and they have tight adductors and tight hamstrings, we may get them started bareback with a blanket because that’s a warm, moving horse, and the muscles can relax and lengthen,” she says. “Now the muscles can get into the stirrups, and still riding bareback, they learn how to use the stirrups.”
Over time, the rider can graduate to a saddle that is functional for them. “Our goal is to help a person take as much ownership or as much command of this activity as independently as possible,” says Fox. “We’re really focused on independence and letting people participate at a level of independence appropriate to their diagnosis and appropriate to their goals.”
Riders attest to the benefits of horse therapy. Dani, who has a spinal cord Injury with quadriplegia and who participated in a program at Hearts Therapeutic in Santa Barbara, California, feels that the program provided her with physical and emotional benefits. “I learned to love the horses and they definitely knew to be gentle with me,” she says. “The highlight of my summer was trotting for the first time on Buddy and a second time on Mondo.” Dani says that she thought her poor balance and leg spasms would preclude her from changing gaits, but that her therapist and the center volunteers helped her. “Trotting seems easy enough to most people, but for me it was exhilarating and empowering,” she says.
There may be certain physical conditions, such as unregulated blood pressure, uncontrolled seizures, and stimming, which preclude participation in horse therapy. A hippotherapy program coordinator should ask questions about your condition in order to match you to a horse and to determine the safety precautions and equipment you require. If they say, “Let’s get on a horse” without first talking to you and understanding your needs, it’s time to find a different program.
When assessing a facility, check the barn to ensure that it is clean and well kept. The horses should be alert and energetic, have shiny coats, and appear healthy. Trust your gut. It’s not necessary to have experience with horses to know what feels right to you.
Next, ask if the instructors are certified. Determine how much experience the instructor has dealing with disabled people, and which types of disabilities they’ve accommodated. Some programs specialize in autism or mental health, whereas others have deep experience with physically disabled people. Just as you wouldn’t skydive with a program that had worn equipment and inexperienced staff, you don’t want to get involved with an amateurish hippotherapy program with untrained staff and temperamental horses.
Once you’ve decided to saddle up, start equipping yourself by finding a good riding helmet. (Bicycle helmets aren’t adequate.) If you’re using stirrups, the therapeutic program should use safety stirrups or breakaway stirrups. Safety stirrups allow the rider’s foot to come out of the stirrup if the person starts to come out of the saddle, while breakaway stirrups detach if the rider’s foot rotates the stirrup too far forward or backward.
In order to get on the horse, you’ll need a mounting block or mounting platform. They are available in various sizes, and some have ramps for wheelchair users. Ensure that the program has an accessible way for you to mount the horse.
Saddles for disabled riders provide for support and stability needed for those with balance issues. Some can have shock absorption, soft padding to prevent pressure sores and side guards to add security. Others have high backs to support a weak spine, back, or shoulder muscles.
Another safety precaution is having one person lead the horse, and another person walk along the side of the horse to help a rider with balance issues.
Make sure that the program takes your condition into account and understands it well. If you feel you are being rushed or not heard, stop and find a program that better meets your needs.
Mia shown at HeartsRiding.org on her WHILL Model M Power Wheelchair
Accessing Horse Therapy
Horse therapy programs are increasingly popular and have become more widespread. Riding My Way Back lists equine therapy centers in 36 states, while the Professional Association of Therapeutic Horsemanship (PATH) International has a directory of 870 member centers and 4,900 certified professionals. You can also google “horse therapy near me” to find opportunities nearby.
You don’t have to have access a formal hippotherapy program to get results. Certified therapeutic horseback riding instructors also teach riding to people with disabilities. Typically, instructors do not have the skills found in a physical therapist or an occupational therapist, but they are experienced with handling horses and they have completed specialized training to learn how to use their horsemanship to help people with disabilities.
If your doctor is familiar with and supportive of hippotherapy, ask them to refer you to a local program. The cost runs between $80 and $115 per session. Some insurers, like Presbyterian Health Plan in Albuquerque, New Mexico, have begun reimbursing for hippotherapy on a case-by-case basis, while other insurers offer full coverage. In some states, Medicaid will cover the cost.
Horse therapy may be a deductible expense on your tax return, if it is as defined in IRS publication 502 as a “diagnosis, cure, mitigation, or treatment…primarily to alleviate or prevent a physical or mental defect or illness.” Medical expenses are deductible only above a threshold of 7.5% of adjusted gross income, or 10% for those who owe alternative minimum tax. Tax deductibility typically involves obtaining a prescription from a doctor and participating in a legitimate hippotherapy program with qualified therapists.
Even if it’s not reimbursable or deductible, horse therapy can still be financially accessible. Project R.I.D.E. in Elk Grove, California, charges $240 for an eight-week session, but offers generous scholarships. High Hopes in Old Lyme, Connecticut, charges $450 for a nine-week semester and $1,350 for a 27-week semester, but offers financial aid. Many horse therapy programs are free to veterans.
Riding into the Sunset
Depending on the program you find, you may start with a quick course on horsemanship. At centers like the Adaptive Sports Center (ASC) in Crested Butte, Colorado, the program includes ranch orientation, instruction on grooming, tacking, behavior around horses, controlling the horse, and arena riding. Adaptive equipment and instruction is provided. “Students work on posture, getting exercise, stretching, working muscles and strengthening body core,” says ASC Program Supervisor Pat Addabbo.
If you find that you loving riding, a world of possibilities opens up. You may fulfill your passion in leisurely trail rides, formal dressage, or something in between. You may be a born competitor like Amberley Snyder, who continued (thanks to a seat belt, Velcro, and a strap) in rodeo barrel racing and breakaway roping after being paralyzed at T12 in a car accident. The Paralympics and Special Olympics have both individual and team events. Whatever your path, you’ll horse therapy will enable you to ride into the sunset with confidence and joy.