The rhythmic, three-dimensional movement of a walking horse can provide a distinctive treatment experience for people with certain physical, sensory, cognitive, and communication needs. Hippotherapy is the skilled use of equine movement as a treatment tool by appropriately trained physical therapists, occupational therapists, and speech-language pathologists. It is incorporated into a patient’s regular plan of care to help achieve specific functional goals; it is not a separate riding program or simply recreational horseback riding.
These 20 questions explain what hippotherapy is, how it differs from adaptive riding, how therapists use equine movement, who may benefit, what the risks and contraindications are, what the scientific evidence shows, and how to find an appropriately qualified provider.
At a Glance: Hippotherapy and Adaptive Riding
| Therapy Incorporating Hippotherapy | Adaptive Riding | |
|---|---|---|
| What is it? | PT, OT, or speech-language therapy in which equine movement is used as a treatment tool | Horseback-riding instruction adapted to the abilities of the participant |
| Primary goal | Functional therapy goals based on an individualized plan of care | Learning riding and horsemanship skills, recreation, fitness, participation, and enjoyment |
| Primary professional | Licensed PT, OT, or SLP working within professional and state scope-of-practice requirements | Qualified riding instructor, often with specialized adaptive-riding training |
| Is the person learning to ride? | Not necessarily; riding skill is not the treatment goal | Yes; learning or improving riding skills is a central goal |
| How is the horse used? | The therapist purposefully selects and modifies the horse’s movement to influence the patient’s sensory, neuromotor, cognitive, or communication systems | The participant learns to influence and control the horse as part of riding instruction |
| How are goals measured? | Through clinical assessment and functional therapy outcomes | Through riding skills, participation, recreation, fitness, and other program goals |
| Medical necessity required? | Yes, when provided as reimbursable health-care therapy | Generally no; it is not ordinarily billed as PT, OT, or SLP treatment |
| May insurance cover it? | Possibly, as part of medically necessary PT, OT, or SLP; coverage varies | Usually not as medical therapy |
Hippotherapy therefore describes how a licensed therapist uses equine movement within treatment, rather than a separate profession or stand-alone treatment service. The American Hippotherapy Association (AHA) recommends terms such as “physical therapy incorporating hippotherapy” rather than “hippotherapist,” “horse therapy,” or “equine therapy.” (American Hippotherapy Association, n.d.-a, n.d.-b)
1. What is hippotherapy?
Hippotherapy is the purposeful use of equine movement as a treatment tool by a physical therapist, occupational therapist, or speech-language pathologist.
The therapist evaluates the patient, identifies functional problems and treatment goals, and determines whether the movement of a horse could help address those goals. The therapist then selects an appropriate horse and deliberately modifies features such as the horse’s pace, direction, movement pattern, and sometimes the patient’s position to produce desired responses.
The patient is receiving physical therapy, occupational therapy, or speech-language pathology services, not a separate medical service called “hippotherapy.”
Best practice is to combine equine movement with other appropriate treatment methods as part of an individualized plan of care. (American Hippotherapy Association, n.d.-a)
2. How is hippotherapy different from therapeutic or adaptive riding?
The major difference is the purpose of the activity and the professional directing it.
In therapy incorporating hippotherapy, a licensed PT, OT, or SLP uses the horse’s movement to address specific functional limitations identified through clinical evaluation. Learning to ride is not the primary goal.
In adaptive riding, an instructor teaches horseback-riding and horsemanship skills using adaptations for people with disabilities or other special needs. Goals may include recreation, fitness, confidence, social participation, competition, and improved riding ability.
Both activities can be valuable. They simply have different purposes.
A person may participate in therapy incorporating hippotherapy for a period of time and later transition to adaptive riding after medical therapy is no longer needed. (American Hippotherapy Association, n.d.-b)
3. Why is it called “hippotherapy”?
The word comes from the Greek hippos, meaning “horse.”
Hippotherapy therefore roughly translates as “treatment with the help of the horse.”
Despite how the word sounds in English, it has nothing to do with hippopotamuses. (American Hippotherapy Association, n.d.-c)
4. How does hippotherapy work?
A walking horse produces repetitive, rhythmic, multidimensional movement. The person sitting on the horse must continually adjust to these changing forces.
Some components of the movement resemble aspects of the movement experienced by the human pelvis and trunk during walking. This does not mean that sitting on a horse exactly reproduces human walking. Rather, it provides repeated movement input that a therapist can use to challenge postural control, balance, coordination, strength, mobility, and sensory processing.
The therapist can alter the treatment by selecting a horse with particular movement characteristics, changing the horse’s speed or direction, using transitions or turns, or changing the patient’s position.
For an occupational therapist or speech-language pathologist, the sensory, postural, attentional, respiratory, or motor responses produced by equine movement may also support functional goals involving activities of daily living, communication, feeding, or other areas within that professional’s scope of practice.
The important point is that the movement is purposefully selected and modified, rather than simply allowing the patient to ride around on a horse. (American Hippotherapy Association, 2026; n.d.-a)
5. Who can benefit from hippotherapy?
There is no single diagnosis that automatically makes someone an appropriate candidate.
Hippotherapy has been incorporated into treatment for some children and adults with conditions such as cerebral palsy, developmental disabilities, traumatic brain injury, stroke, multiple sclerosis, Down syndrome, autism spectrum disorder, and other conditions affecting movement, posture, balance, sensory processing, communication, or functional activity.
However, a diagnosis alone does not determine whether hippotherapy is appropriate.
The therapist should consider the person’s specific impairments, functional goals, medical condition, ability to tolerate equine movement, safety risks, and whether the movement of a suitable horse is likely to contribute meaningfully to the treatment plan.
Two people with the same diagnosis may therefore receive very different recommendations. (American Hippotherapy Association, 2021)
6. What specific goals or outcomes can hippotherapy address?
Goals depend on whether the patient is receiving physical therapy, occupational therapy, or speech-language pathology and on that patient’s individual needs.
Examples may include improvement in:
- postural control and trunk stability;
- balance;
- coordination;
- mobility and gait-related function;
- motor planning;
- strength and endurance;
- range of motion;
- sensory processing and regulation;
- attention and engagement;
- functional use of the upper extremities;
- activities of daily living;
- respiratory support for speech;
- speech, language, or other communication skills; and
- participation and functional independence.
These are treatment goals, not guaranteed benefits of being around a horse. The therapist should identify measurable goals and periodically evaluate whether incorporating equine movement is actually helping the patient make progress toward them.
7. Is hippotherapy within the scope of practice of PTs, OTs, and speech-language pathologists?
The American Hippotherapy Association reports longstanding recognition by the American Physical Therapy Association, American Occupational Therapy Association, and American Speech-Language-Hearing Association that skilled equine movement may be incorporated into PT, OT, and speech-language pathology practice. (American Hippotherapy Association, n.d.-a)
However, professional scope is only part of the issue.
A clinician’s actual authority to practice is also affected by state licensing laws, professional regulations, education, competence, and individual training. Both APTA and AOTA emphasize that state practice acts help define the legal scope of licensed professionals. (American Occupational Therapy Association, n.d.; American Physical Therapy Association, n.d.)
Therefore, being a PT, OT, or SLP does not automatically mean that a clinician is qualified to incorporate hippotherapy. The clinician also needs appropriate knowledge and competency in equine movement, horsemanship, safety, and clinical application.
8. What does a typical therapy session incorporating hippotherapy look like?
There is no single standard session.
The therapist first determines the day’s treatment needs and confirms that the patient’s medical status and the horse’s condition make equine movement appropriate.
The treatment team commonly includes the therapist, a trained horse handler, the horse, and, when needed, one or more trained assistants or side-walkers. The exact team depends on the patient and setting.
During the equine-movement portion of treatment, the therapist may adjust:
- which horse is used;
- the horse’s speed;
- direction of travel;
- straight lines versus curves;
- transitions and stops;
- the patient’s position;
- activities performed while moving; and
- the duration or intensity of movement.
A therapy session may also include conventional PT, OT, or speech-language activities before or after the equine-movement portion.
For this reason, there is no universal rule that a session must last 30, 45, or 60 minutes or that the patient must spend the entire therapy session on the horse.
9. Is hippotherapy safe, and what are the main risks?
Working with horses always involves some risk.
Horses are large animals capable of sudden movement, even when carefully selected and well trained. Falls, kicks, bites, crushing injuries, or other accidents are possible. Treatment may also occur in environments affected by heat, cold, dust, allergens, uneven surfaces, and other hazards.
Risk should be reduced through:
- careful patient screening;
- appropriately selected and trained horses;
- qualified horse handlers;
- therapists trained in the use of equine movement;
- trained assistants when needed;
- appropriate helmets and other safety equipment;
- emergency procedures;
- suitable mounting and dismounting methods;
- continual monitoring of the patient and horse; and
- reassessment when a patient’s medical condition changes.
The AHA emphasizes that hippotherapy should not be used when an essential member of the treatment team is unavailable or inadequately trained. (American Hippotherapy Association, 2021)
Safety is therefore not simply a characteristic of a “calm horse.” It depends on the entire clinical and equine system.
10. Who should not participate in therapy incorporating hippotherapy?
There are both contraindications and precautions, and they require individualized clinical judgment.
AHA best-practice guidance identifies conditions that may make equine movement inappropriate, including examples such as:
- unstable spine or joints;
- some symptomatic cervical-spine abnormalities;
- uncontrolled major seizures;
- acute herniated disc;
- certain untreated pathologic fractures or severe bone fragility;
- some painful or acutely worsening medical conditions;
- open wounds in areas subjected to pressure;
- recent surgery or unstable hardware;
- conditions in which the movement would increase pain or reduce function; and
- behavior that creates an unacceptable risk to the patient, horse, or treatment team.
Other factors (including allergies, sensory intolerance, skin conditions, fatigue, medications, body size, fear, and the ability to mount, position, and support the patient safely) may require additional precautions rather than automatically ruling treatment out. (American Hippotherapy Association, 2021)
Contraindication lists should therefore not be used as a do-it-yourself checklist. The treating therapist should assess the patient and obtain appropriate medical consultation when needed.
11. What qualifications should a provider have?
The clinician responsible for therapy should first be an appropriately licensed or credentialed physical therapist, occupational therapist, or speech-language pathologist, or an appropriately supervised assistant where permitted.
In addition, the clinician should have specialized education in incorporating equine movement into clinical treatment. This requires knowledge beyond ordinary PT, OT, or speech-language education, including:
- equine movement and biomechanics;
- patient-horse matching;
- horse behavior;
- safety;
- contraindications and precautions;
- treatment-team roles;
- therapeutic positioning;
- clinical reasoning; and
- emergency procedures.
The [American Hippotherapy Association] offers post-professional education in these areas.
Voluntary professional credentials are also available through the [Hippotherapy Certification Board (AHCB)]. Its Hippotherapy Clinical Specialist (HPCS®) credential represents advanced experience and knowledge. Current eligibility includes professional licensure, substantial clinical experience, at least 100 hours of direct treatment using hippotherapy during the specified period, and significant horse experience. (Hippotherapy Certification Board, n.d.-a)
Certification is useful evidence of specialized preparation, but it does not replace professional licensure, clinical judgment, or current competence.
12. Is there scientific evidence supporting hippotherapy?
Yes, but the strength of the evidence varies considerably by diagnosis and outcome.
The best-studied population is children with cerebral palsy. A 2025 systematic review included 25 studies involving 602 children and found evidence of improvements in gross motor function, particularly standing and walking-related dimensions. However, the authors also noted limitations including small sample sizes and lack of blinding. (Bernardino et al., 2025)
Other studies have examined balance, posture, gait, sensory-motor function, multiple sclerosis, stroke, autism, and other populations, but the amount and quality of evidence are not equal across these conditions.
It is therefore too broad to say simply that “hippotherapy works” for all of the diagnoses for which it is used.
A better conclusion is that there is supportive evidence for selected outcomes and populations (particularly motor outcomes in cerebral palsy) but additional high-quality research is needed to determine which patients benefit most, which treatment approaches work best, and how durable the effects are.
13. Are there age or weight restrictions?
There is no universal minimum age, maximum age, or single weight limit for hippotherapy.
The original question is important because many programs establish their own practical limits, but those limits depend on several factors.
For young children, the therapist considers developmental readiness, medical status, the treatment goal, availability of an appropriate horse, and whether the treatment team can safely position and support the child. AHA recommends especially experienced clinicians for children under age 3. (American Hippotherapy Association, n.d.-c)
There is no general upper age limit.
Weight also cannot be reduced to a single percentage of the horse’s body weight. Programs must consider the horse’s size, conformation, conditioning, soundness, movement quality, equipment, workload, the patient’s balance and ability to support their own weight, and the ability of staff to assist safely.
A facility may therefore establish a weight limit based on its particular horses, staff, equipment, and safety procedures. Another program with different resources may have a different limit.
14. Is hippotherapy covered by insurance?
Sometimes—but the terminology is important.
Hippotherapy is a treatment tool, not a separate billable health-care profession or stand-alone service. There is no special CPT code simply for “hippotherapy.”
When equine movement is incorporated into medically necessary physical therapy, occupational therapy, or speech-language pathology, the clinician documents and bills the skilled therapy services using appropriate therapy procedures, just as other treatment tools are incorporated within therapy. (American Hippotherapy Association, n.d.-d)
Coverage depends on factors such as:
- the patient’s insurance plan;
- medical necessity;
- diagnosis and functional limitations;
- the therapist’s provider status;
- applicable therapy benefits;
- documentation;
- authorization requirements; and
- exclusions in the insurance contract.
Some insurers may specifically restrict or exclude treatment involving horses.
Families should therefore ask both the treatment provider and insurer about coverage before beginning treatment rather than assuming that “hippotherapy” itself is either automatically covered or automatically excluded.
15. How do I find a qualified hippotherapy program or practitioner?
Begin by looking for a licensed PT, OT, or SLP (or an appropriately supervised therapy assistant) who has specialized education and experience incorporating equine movement into clinical care.
Useful questions include:
- What is the clinician’s professional license?
- What specialized hippotherapy education has the clinician completed?
- Does the clinician hold AHCB certification or the HPCS® credential?
- How are patients evaluated and treatment goals established?
- How are horses selected for individual patients?
- Who handles the horse?
- How are assistants and side-walkers trained?
- What safety and emergency procedures are in place?
- How is progress measured?
- How are the horses’ health, conditioning, workload, and welfare monitored?
The American Hippotherapy Association maintains a [Find a Therapist & Facility] directory. Its listings require specified AHA education or recognized AHCB credentials. (American Hippotherapy Association, n.d.-e)
The Hippotherapy Certification Board also provides information about credentialed clinicians.
16. Does a patient need to know how to ride a horse?
No.
The patient is not required to know how to ride because learning horseback riding is not the purpose of hippotherapy.
In adaptive riding, the participant gradually learns skills such as steering, stopping, controlling pace, mounting, and other aspects of horsemanship.
During PT, OT, or speech-language therapy incorporating hippotherapy, the therapist controls the treatment variables while a trained horse handler generally controls the horse. The patient’s job is not necessarily to learn to direct the animal.
In fact, asking a patient to control the horse could sometimes interfere with the specific movement input the therapist is trying to provide.
A person can therefore benefit from equine movement without becoming an independent horseback rider. (American Hippotherapy Association, n.d.-b)
17. How is a horse selected for a particular patient?
Not every safe riding horse is suitable for hippotherapy, and not every therapy horse is appropriate for every patient.
The therapist considers characteristics such as the horse’s:
- movement quality;
- stride length and rhythm;
- amount and direction of movement transmitted to the patient;
- size and body shape;
- symmetry;
- temperament;
- responsiveness to the handler;
- ability to change pace or movement as requested;
- physical condition and soundness; and
- tolerance of patients, assistants, equipment, and unusual movement.
The therapist then matches those characteristics to the patient’s body size, impairments, goals, and ability to respond to movement.
One patient may need relatively small, smooth movement while another may benefit from greater movement challenge.
The process of matching and deliberately grading equine movement to the patient’s needs is one of the features that distinguishes skilled clinical use of hippotherapy from simply putting someone on a suitable horse. (American Hippotherapy Association, n.d.-b)
18. Does all of the therapy take place while the patient is sitting normally on the horse?
No.
The treatment plan may include activities both with and without equine movement, because hippotherapy is only one tool within PT, OT, or speech-language therapy.
When equine movement is used, the patient’s position may also vary according to clinical goals and safety. A therapist may use different developmentally appropriate positions to change how movement is transmitted through the patient’s body.
The therapist may also combine equine movement with reaching, communication tasks, postural challenges, transitions, or other therapeutic activities.
Treatment should not consist of keeping every patient in the same position while the horse repeatedly follows the same path. The clinician adjusts the treatment according to the patient’s response. (American Hippotherapy Association, n.d.-b)
19. How does the therapist know whether hippotherapy is helping, and when should it stop?
Hippotherapy should be held to the same basic standard as other skilled therapy: it should contribute to measurable functional progress.
Before treatment, the therapist identifies functional problems and establishes goals. Progress may then be evaluated through standardized outcome measures, clinical measurements, observation of function, patient or caregiver reports, and performance in everyday environments.
The therapist should periodically ask:
- Is the patient making meaningful progress?
- Is equine movement contributing to that progress?
- Are the treatment goals still medically necessary?
- Could another treatment tool now address the goals as well or better?
- Do the benefits continue to outweigh the risks?
- Has the patient’s medical status changed?
AHA best-practice guidance specifically emphasizes ongoing reassessment because a patient’s condition can change and a new precaution or contraindication may arise. (American Hippotherapy Association, 2021)
When skilled therapy is no longer medically necessary, the patient may be discharged from therapy even if they enjoy being with the horse. A person who wants to continue riding may then be referred to an appropriate adaptive or recreational riding program. (American Hippotherapy Association, n.d.-c)
20. What about the health and welfare of the horse?
The horse is a living member of the treatment team, not simply a piece of therapy equipment.
A horse used for clinical treatment needs appropriate:
- veterinary and hoof care;
- nutrition and hydration;
- conditioning;
- rest;
- suitable housing and turnout;
- tack and equipment;
- workload limits;
- training;
- handling; and
- monitoring for pain, lameness, fatigue, stress, or behavioral changes.
The therapist and equine professionals must also consider whether a particular patient or activity is appropriate for the horse. An intervention that places excessive physical or psychological stress on the horse is not acceptable simply because it might benefit the patient.
AHA best-practice guidance specifically notes that equine movement may be contraindicated when the human-animal interaction is detrimental to either the patient or the horse. (American Hippotherapy Association, 2021)
Protecting equine welfare is therefore both an ethical responsibility and a clinical concern. A horse that is uncomfortable, fatigued, frightened, or unsound cannot provide the consistent, safe, high-quality movement on which the treatment depends.
References
American Hippotherapy Association. (2021). Statements of best practice for the use of hippotherapy by occupational therapy, physical therapy, and speech-language pathology professionals.
American Hippotherapy Association. (2026). Hippotherapy conceptual framework. American Hippotherapy Association.
American Hippotherapy Association. (n.d.-a). What is hippotherapy? American Hippotherapy Association.
American Hippotherapy Association. (n.d.-b). Media kit and recommended terminology for hippotherapy. American Hippotherapy Association.
American Hippotherapy Association. (n.d.-c). Frequently asked questions. American Hippotherapy Association.
American Hippotherapy Association. (n.d.-d). Terminology for healthcare and reimbursement. American Hippotherapy Association.
American Hippotherapy Association. (n.d.-e). Find a therapist & facility. American Hippotherapy Association.
American Occupational Therapy Association. (n.d.). Occupational therapy scope of practice. American Occupational Therapy Association.
American Physical Therapy Association. (n.d.). Scope of practice. American Physical Therapy Association.
American Speech-Language-Hearing Association. (2016). Scope of practice in speech-language pathology. American Speech-Language-Hearing Association.
Bernardino, I., Borges, D. F., Casalta-Lopes, J., & Soares, J. I. (2025). Hippotherapy improves gross motor function in children with cerebral palsy: Evidence from a systematic review. Physical & Occupational Therapy in Pediatrics, 57(4), 489-503. doi:10.1177/10538135251387278.
Hippotherapy Certification Board. (n.d.-a). Hippotherapy Clinical Specialist examination and eligibility requirements.
Hippotherapy Certification Board. (n.d.-b). Exams and certification.