Equine Assisted Therapy

Early study of riding and disability

A 2014 overview in Animal Frontiers credits Chassaigne, a French neurologist, with the first study of the effects of riding on people with disabilities, dated to 1870. According to that overview he concluded that riding improved balance, posture and muscle control, and that people with neurological disorders benefited most. The overview does not give a primary reference, so this account rests on a single secondary source.

This page does not date earlier writing about riding and health. The sources opened for this draft either did not cite primary texts for such claims or could not be opened, and popular accounts that trace the idea to classical authors were not verified.

Twentieth-century rehabilitation and Lis Hartel

The same overview says that a hospital in Oxford, England, paired wounded soldiers returning from World War I with cavalry horses for rehabilitation, and gives no further detail. It also describes the Danish dressage rider Lis Hartel, who won a silver medal at the 1952 Helsinki Olympics although she was partly paralyzed by polio, and presents her success as a turning point in public awareness of the connection between horses and people.

Entry into mental health research

Use of horses in psychotherapy and for trauma is described as more recent. A 2024 systematic review of equine-assisted services for military veterans with post-traumatic stress disorder (PTSD) calls the field early in its development, with limited rigorous research and non-standardized interventions. Its 13 included studies were published between 2016 and 2023, and a separate 2023 review of the same question included studies from 2018 onward.

Equine-assisted services as an umbrella

A 2024 review describes equine-assisted services as horse use within therapy, learning or horsemanship, with three branches: therapy, for example psychotherapy involving horses; learning; and therapeutic horseback riding. In that framework, therapy is delivered by a licensed professional, and the review lists counseling, occupational therapy, physical therapy, psychotherapy and speech-language therapy. It distinguishes these from sessions that simply teach a person to ride or care for a horse.

Terms are not used consistently. A 2022 scoping review of services for substance use disorders found programs labeled horse-assisted therapy, equine-assisted learning, equine-assisted psychotherapy and equine-facilitated psychotherapy, and listed non-standardized terminology among its limits.

Hippotherapy

The American Hippotherapy Association describes hippotherapy as a tool in which occupational therapy, physical therapy and speech-language pathology professionals use evidence-based practice and clinical reasoning to purposefully manipulate equine movement, aiming to engage sensory, neuromotor and cognitive systems and support functional outcomes. It states that hippotherapy is not a separate service or program, and that it is integrated into a plan of care alongside other strategies.

Labels pooled in reviews

Review authors often combine several practices under one name. A 2025 meta-analysis searched for therapeutic riding, horseback riding, hippotherapy, equine-assisted therapy, equine movement therapy and related terms, then reported the results together as equine-assisted therapy. A reader should not assume that a result for one of these practices applies to the others, or to equine-assisted psychotherapy, which was not part of that review.

Psychotherapy incorporating horses

Of 13 studies in the 2024 veterans review, eight used psychotherapy incorporating horses, in which an equine specialist leads activities with the horses while a licensed mental health professional provides psychotherapy. Activities included groundwork, grooming, leading horses, teamwork and riding, and the psychotherapy components included reflection, observation, psychoeducation and goal setting.

Programs differed widely. Some were intensive, others met once a week for 4 to 8 weeks or for 6 months, with sessions lasting from 60 minutes to 3 hours. In the therapeutic riding studies, participants were assigned the same horse so that a bond could form. Only 3 of 10 studies in another review addressed matching of horse and participant or horse well-being.

Hippotherapy and therapeutic riding in trials

In the 27 studies of the 2025 meta-analysis, mounted sessions typically lasted 20 to 60 minutes, once or twice a week, over programs running from a single session to about a year, most often 8 to 12 weeks. Participants included children with cerebral palsy, older adults, and adults with multiple sclerosis or stroke. In a 2024 review of hippotherapy for children with cerebral palsy, the hippotherapy was usually combined with conventional therapy and no standard protocol existed.

Sessions and the horses' working day

A 2026 observational study at one U.S. equine center followed ten horses averaging about 3 hours of work a week. Riding sessions averaged about 35 minutes and ranged from 9 to 66 minutes depending on client needs, and each session had a preparation phase of grooming and tacking up, a hand-walked phase and a riding phase. The center is one facility, so it may not represent other programs.

Motor function and balance

Authors of the 2025 meta-analysis describe the rationale for mounted work as the rhythmic movement of the horse, which they say resembles a human walking pattern, and they state that riders with physical disabilities often show gains in flexibility, balance, strength and coordination. These are claims in the review's introduction, and the review then tested a narrower set of outcomes in children with cerebral palsy, older adults and adults with multiple sclerosis or stroke.

Trauma, mood and behavior

For mental health, the 2024 veterans review states that equine-assisted services are increasingly used with trauma survivors and may be associated with reduced depression and anxiety. Its authors also write that the non-judgmental nature of horses helps foster relationships, and that peer support, learning new skills and bonding may be additional benefits. They add that these perceived benefits need confirmation in well-controlled, high-quality studies.

A 2022 scoping review reported that participants in programs for adolescents and young adults with substance use disorders described bonds with horses, greater self-efficacy, improved mood and more motivation for treatment, while a few described negative or indifferent experiences.

Motor outcomes across conditions

The 2025 systematic review and meta-analysis searched to April 2022 and included 27 studies, 15 of which supplied data for pooling. It found 14 studies in cerebral palsy with 611 participants. Pooled results were statistically significant for only two outcomes: the walking, running and jumping dimension of the Gross Motor Function Measure in children with cerebral palsy (mean difference 2.48 points, p = 0.009) and the Timed Up and Go test in older adults and stroke survivors (about 0.6 seconds faster).

Pooled balance scores in cerebral palsy, multiple sclerosis, stroke and older adults, and the other motor dimensions, did not reach significance. Randomized trials averaged 24.8 of 32 on the review's quality tool and non-randomized studies 19.7, and few studies concealed allocation. The authors concluded that the therapy is beneficial, which is broader than the two significant pooled results.

Hippotherapy for children with cerebral palsy

A 2024 systematic review of hippotherapy and motor function in children with cerebral palsy included ten studies with 541 participants, published from 2015 to 2023, drawn from PubMed and Scopus. Findings were mixed. Some studies reported gross motor gains, one found no change in the total score of the Gross Motor Function Measure but a rise in the walking, running and jumping dimension, and another found gains that were not sustained at follow-up.

Randomized studies scored 4 to 8 on the PEDro scale, no study blinded therapists, and the authors list small samples, no standard protocol, mostly short-term follow-up and unproven long-term effects as limits. The review text gives both ten and eleven as the number of included articles, a discrepancy a reader should know about.

Veterans with PTSD

The 2024 review of equine-assisted services for military veterans with PTSD included 13 studies and 344 participants. Eleven were uncontrolled clinical studies, and the two randomized trials reported on a single study. Pooled PTSD Checklist scores fell by a mean of 12.46 points (95% confidence interval 9.03 to 15.88), but the authors judged most studies to be of low quality, with moderate to high risk of bias. Benefits were short term, up to 6 months, with no follow-up beyond a year.

A 2023 review of ten studies in the same population did not assess risk of bias formally. Only one was labeled a randomized trial, open trials were noted to risk inflating results, and concurrent psychotherapy or medication could have contributed. At 3 months, three of five responders in one pilot study maintained their response.

Substance use disorders

The 2022 scoping review found nine studies, six qualitative and three quantitative. One cohort found longer stay in treatment with horse-assisted therapy (mean 141 versus 70 days). The one randomized trial, with 37 participants, found no significant difference, with completion of 44 percent versus 32 percent. The authors judged effectiveness as an adjunct to be inconclusive and stated that more research is needed before broad implementation.

Design limits shared across reviews

Across the reviews opened for this page, the recurring limits are small samples, few randomized trials, heterogeneous and non-standardized programs, short follow-up and uncontrolled before-and-after designs. The substance use review also notes possible publication bias and positive-focused qualitative reporting by authors who may favor horses, and the veterans review notes that many programs were provided at no cost to participants.

Open questions about how it might act

Mechanisms are untested in the sources reviewed. In a 2024 experiment, 42 horse-naive university students interacted for 6 minutes with the same four horses, once when a horse had been made stressed by lunging and once when it was relaxed. Students did not differ in anxiety, mood or cortisol between conditions, although all measures fell over time. The study was short, used a healthy young sample and does not show what happens in real therapy.

Participant harms and injuries

The cerebral palsy review reported no adverse events or safety outcomes for any included study. In the veterans review, one study described minimal adverse effects and another called the program safe, but adverse events were not systematically reported, and riding safety precautions were described in only 4 of 10 studies. The substance use review reported no safety data, and some participants described fear of horses.

No source found for this page gives injury rates for hippotherapy or therapeutic riding. A 2010 hospital series of recreational riders in England counted 199 injuries in 155 patients, 69 percent from falls, with 24.5 percent of patients injured in the head. The authors link the absence of moderate or severe head injury to 98 percent helmet use. That series does not concern therapeutic riding, so it cannot be used to estimate risk in a program.

Horse welfare

The 2026 observational study of ten program horses, about 20 years old on average, found no difference in stress and pain behaviors between able-bodied riders and clients with or without significant physical impairment. Horses showed more such behaviors during grooming and tacking up than while ridden. Four of ten had high ACTH hormone levels that led to adjusted medication, five of ten were not seen lying down in 24 hours, and the authors raised night lighting as a possible factor. The authors state that rider imbalance is considered a frequent cause of back pain in horses.

A small pilot of 11 horses in a program for youth with trauma histories found no difference in eye temperature, cortisol or stress behaviors compared with a program for young adults with developmental disabilities, with values within normal ranges. The authors note the small sample, the selection of calm horses and the lack of a matched comparison group.

Suitability and professional roles

No source reviewed lists formal contraindications. The 2024 veterans review concludes that equine-assisted services are best placed as an adjunct to other therapy, not a replacement, and the substance use review does not support broad implementation. Equine-assisted therapy should not delay or replace medical care or standard psychotherapy, and new or worsening symptoms warrant assessment by a clinician.

The American Hippotherapy Association states that hippotherapy is delivered by licensed or credentialed occupational therapy, physical therapy and speech-language pathology professionals. Certification pages of the Professional Association of Therapeutic Horsemanship International could not be opened, so its credentials for riding instructors and equine specialists are not described here.