Donaldson M. et al
Journal of Equine Vet. Science (2019)

Description 
Although horseback riding is a well-established means of rehabilitation therapy for a variety of human patients, there are few data on the biomechanical relationships between horse and rider during such hippotherapy. We simultaneously tracked the movements of a horse with several different novice riders, under conditions similar to hippotherapy, to evaluate whether horses pass the same motion to different riders while being lead at a walk. 

Results 
We found consistent rhythmic motion in the horse's hock, shoulder, and knee. There were no significant differences in equine movement across six different riders, supporting the conclusion that horses can be used as a reproducible rehabilitation platform for riders. Moreover, although riders demonstrated different baseline postures, there were no significant differences in their ranges of motion in each joint. 

Conclusion
These results indicate that a horse can reproducibly influence a population of participants in a hippotherapy situation.

Janura, Peham, Dvorakova, Elfmark
Human Movement Science (2009)

Description 
Hippotherapy employs locomotion impulses that are emitted from the back of a horse while the horse is walking. These impulses stimulate the rider's postural reflex mechanisms, resulting in training of balance and coordination. The aim of the present study was to assess the changes in magnitude and distribution of the contact pressure between the rider and the horse during a series of hippotherapy lessons.

Conclusion
The lateral movement of the horse’s abdomen produces COP deviations in a medio- lateral direction. It is followed by the rider’s pelvic movement. In this direction, the center of gravity of the rider’s body deviates from the expected direction of willful locomotion. COP deviation values are higher here in comparison to the anteroposterior movement and the movement is characterized by less stability. Jeffcott et al. (1999) reported that the combination of an unbalanced horse and rider caused large lateral deviation of the COP.

Janura, Svoboda, Cabell, Dvorakova, & Jelen
Neuro endocrinology letters (2015)

Description 
To assess the rider's movement during walking the horse in repeated therapeutic horse riding sessions and to determine the relationship between movements of the horse's back and the rider's trunk.

Results 
The mediolateral displacements of C7, Th12, and L5 were gradually decreasing in each of the first three sessions. Statistically significant differences (p<0.05) were found between individual sessions in the displacement of C7, Th12 and L5 in the mediolateral and vertical directions as well as in the shoulder and pelvic lateral tilt and rotation. These differences did not show any general tendencies regarding the riders' increasing experiences with riding. The relationships between the displacement of C7, Th12, and L5 and the sacral tuber on the horse's back in the vertical direction were statistically significant (p<0.01) during all sessions.

Conclusion
The displacement of C7, Th12 and L5 in the mediolateral direction decreased during riding sessions. A significant relationship was found between the vertical movement of the horse’s back and the rider’s trunk. These relationships differed between the horses.

Hilliere, Collado-Mateo, Villafaina, Duque-Fonseca, Parraca
PM&R (2018)

Description 
To provide an up-to-date research analysis on equine-assisted therapies and horse riding simulation exercise in older adults, and to suggest future directions in clinical practice and research. TYPE: Systematic review.

A comprehensive search of studies was performed in 4 electronic databases (Cochrane, PubMed, PEDro, and Web of Science) regarding the effects of equine-assisted therapies and horse riding simulation exercise in older adults. Eight articles were selected, 5 of them focused on hippotherapy, 2 on horse riding simulation, and a single article that used the 2 types of therapy.

Conclusion
Results indicate that hippotherapy might improve balance, mobility, gait ability, and muscle strength, as well as could induce hormonal and cerebral activity changes in healthy older adults. Benefits of horse riding simulation could be limited to physical fitness and muscular activity.

Kitagawa T, et.al
Journal of Physical Therapy Science (2001)

Description 
It is well known that active horseback riding therapy is effective for body muscle function and psychological well-being. Initially, we wanted to introduce this horseback riding therapy into Japan. But, there are practical difficulties with regard to keeping horses in our country, especially in hospitals of urban areas. Therefore, we think the only (practical) method of reproducing horseback riding conditions is the simulator. One purpose of the development of a horseback riding simulator is to make an assessment system and to establish a training system for body-balance functions. Another purpose is for the strengthening of leg and trunk muscles through active prevention of loss of balance. Consequentially, the muscles are trained, and the simulator leads to the treatment of Lower Back Pain.

Conclusion
The myo-electrical discharge of lumbodorsal and abdominal muscles suggest that horse riding therapy with the simulator would be effective.

Flores F et al
Brazilian journal of Physical Therapy (2015)

Description 
Hippotherapy uses horseback riding movements for therapeutic purposes. In addition to the horse's movement, the choice of equipment and types of floor are also useful in the intervention. The quantification of dynamic parameters that define the interaction of the surface of contact between horse and rider provides insight into how the type of floor surface variations act upon the subject's postural control.

To test whether different types of surfaces promote changes in the amplitude (ACOP) and velocity (VCOP) of the center of pressure (COP) displacement during the rider's contact with the saddle on the horse's back.

Results
ACOP values were higher in sand, followed by grass and asphalt, with significant differences between sand and asphalt (anteroposterior, p=0.042; mediolateral, p=0.019). The ACOP and VCOP values were higher in the anteroposterior than in the mediolateral direction on all surfaces (ACOP, p=0.001; VCOP, p=0.006). The VCOP did not differ between the surfaces.

Conclusion
Postural control, measured by the COP displacement, undergoes variations in its amplitude as a result of the type of floor surface. Therefore, these results reinforce the importance of the choice of floor surface when defining the strategy to be used during hippotherapy intervention.

Ribeiro, Espindula, Junior, Tolentino, Ribeiro da Silva, Araujo, Ferreira, Teixeira
Journal of Body Work and Movement Therapies (2018)

Description 
To analyze muscle activation of lower limbs (LL) of subjects in hippotherapy sessions

Results
The analysis of muscle activity during these four sessions showed a significant difference in muscle recruitment in LL, and sessions with blanket and feet in the stirrups provided greater muscle activation of quadriceps and tibialis anterior with the horse at step gait (p = 0.0002).

Conclusion
The analysis of muscle activity during these four sessions showed a significant difference in muscle recruitment in LL, and sessions with blanket and feet in the stirrups provided greater muscle activation of quadriceps and tibialis anterior with the horse at step gait (p = 0.0002).

Uchiyama H, Ohtani N, Ohta M
Applied Animal Behavior Science (2011)

Description
Therapeutic horse riding or hippotherapy is used as an intervention for treating individuals with mental and physical disabilities. Equine-assisted interventions are based on the hypothesis that the movement of the horse's pelvis during horseback riding resembles human ambulation, and thus provides motor and sensory inputs similar to those received during human walking. However, this hypothesis has not been investigated quantitatively and qualitatively. This study aimed to verify the hypothesis by conducting a three-dimensional analysis of the horse's movements while walking and human ambulation. Using four sets of equipments, we analyzed the acceleration patterns of walking in 50 healthy humans and 11 horses. In addition, we analyzed the exercise intensity by comparing the heart rate, breathing rate, and blood pressure of 127 healthy individuals before and after walking and horse riding. The acceleration data series of the stride phase of horse walking were compared with those of human walking, and the frequencies (in Hz) were analyzed by Fast Fourier transform.

Results
Exercise intensity, as measured by the heart rate and breathing rate, was not significantly different between horse riding and human walking. The levels of diastolic blood pressure were slightly higher during horse riding than during walking, but were lower during both conditions compared with those in normal conditions (P < 0.01). 

Conclusion
The present study shows that horse riding provides motor and sensory inputs through variations in gravity, and that the acceleration of the horse while walking was comparable with that of human walking quantitatively and qualitatively. Our results indicate that horse riding at a walking gait provides stimulation (i.e. acceleration) highly similar to that generated by human walking, and thus provides optimum treatment benefits to individuals with ambulatory difficulties.

Janura, Svoboda, Dvorakova, Cabell, Elfmark & Janurova
Kinesiology (2012)

Description 
The impulses emitted from the back of a horse during hippotherapy stimulate the rider’s postural reflex mechanisms, resulting in balance and coordination training. The objectives of this study were to evaluate the movement variability of the horse’s back and limbs and to determine significant relationships between the movement of the selected body points on the horse. 

Results 
There were no significant differences between individual trials in a given session throughout the whole measuring process.

Conclusion
The movement of the horse in a given session was stable and the differences in the vertical displacement of the observed points on the limbs and back of the horse were not significant.