Pediatrics: Hippotherapy vs. Adaptive Riding
by Justine Gonzales, OTR/L
Kids Place Central Occupational Therapist

The terms hippotherapy and adaptive riding (formally known as therapeutic riding) are commonly misused. While both approaches incorporate the benefits of riding a horse, there are various differences among the two. To ensure children are receiving the most appropriate horseback riding approach, it is important for parents to be able to distinguish the different purposes of hippotherapy and adaptive riding.

First, though, let’s identify the benefits of both therapies. Riding a horse provides children with beneficial motor and sensory input. The repetitive motion of a horse while ambulating offers riders with rhythmic and multidimensional movements that activate the pelvis, similar to a human gait pattern. Children benefit from the body movement, muscle strengthening, proper posture, balance, improved attention, and improved social emotional regulation horseback riding can provide.

Hippotherapy involves using the movement of a horse as a treatment tool incorporated by your child’s therapist. This strategy is implemented by licensed therapist trained through coursework from the American Hippotherapy Association on the treatment principles of equine movement and how to skillfully apply them to a patient’s plan of care. Alongside the licensed therapist, a competent horse handler aids in the hippotherapy modality to ensure the trained therapy horse is delivering safe movements for the child. Equine movement can help engage a child’s sensory, neuromotor, and cognitive system to improve daily functioning. Hippotherapy can be used to treat children with various diagnoses such as autism, cerebral palsy, Down syndrome, behavioral disorders, and other neurological and physical disabilities. Because hippotherapy is a therapy tool integrated into occupational, physical, or speech therapy, it is reimbursable by medical insurance.

Adaptive riding, also known as therapeutic riding, focuses on teaching children specific riding skills. As of December 2018, the American Hippotherapy Association has recommended the term “adaptive riding” to replace “therapeutic riding” to avoid confusion. Adaptive riding is provided by certified therapeutic horseback riding instructors who are required to complete a workshop and certification exam offered by the Professional Association of Therapeutic Horsemanship International (PATH Intl). Certified therapeutic horseback riding instructors often work alongside volunteers or other staff members who aid in delivering the horseback riding lessons to children with disabilities. Horses used during adaptive riding are screened to ensure they possess the appropriate temperament necessary in order to work with children. Classes may sometimes be taught in a group format depending on the adaptive riding location. Unlike hippotherapy, adaptive riding is not covered by insurance because it is a leisure and recreational activity.

Hippotherapy and adaptive riding are both beneficial approaches that families can consider for their child. In addition to being able to identify the differences between the two, it is also crucial for parents to be aware of essential considerations when their child is riding a horse:

  • Any form of horseback riding may not be appropriate if movement decrease’s the patient’s function, increases pain, or aggravates a medical condition.
  • If the child is not comfortable interacting with horses, this can be harmful to the child and horse.
  • When riding a horse, there is a potential risk for a fall of 4 to 6 feet above the ground.
  • Interacting with a horse may involve unpredictable risks especially if/when horses have their instinctive fight or flight responses.
  • Dust allergens and medication interactions with light and elevation should be considered especially when offered outdoors.


American Hippotherapy Association, Inc. (2018). AHA, Inc. Terminology Guidelines. Retrieved from

American Hippotherapy Association, Inc. (2017). Statements of Best Practice for the Use of Hippotherapy by Occupational Therapy, Physical Therapy, and Speech-Language Pathology Professionals. Retrieved from

Koca, T. T., & Ataseven, H. (2016). What is hippotherapy? The indications and effectiveness of hippotherapy. Northern clinics of Istanbul2(3), 247–252. doi:10.14744/nci.2016.71601