Therapeutic Riding Horse Health

The work therapy horses such as Elliot perform is priceless; their health and welfare should be, as well.

Photo: Courtesy Christa Lesté-Lasserre

Like most Parisians, Tina and Elliot wake up every morning in the bustling city and get ready for work. They don’t drink coffee and take showers, but they do eat their grain and have their black coats groomed to a shine. They leave their stables, cross the paddock, and arrive for duty promptly at 8:30 a.m. This hard-working, sturdy duo—Tina, an Icelandic horse, and Elliot, a Merens draft type—are therapy horses. Right in south central Paris, France, they partner with the mentally and physically challenged patients of the neighboring institution, Notre Dame de Joye. They also receive visiting patients from psychologists and social workers and groups from juvenile detention centers.

Tina and Elliot’s job is no light matter. The physical and mental demands on these horses are many. But researchers have shown that equine therapy (what they call “hippotherapy”) benefits human patients dealing with all kinds of challenges. For the patients and the therapists, these horses’ roles—and their health and welfare—are priceless. By properly selecting, training, and managing these horses, along with providing optimal preventive care, we can help ensure their good health is preserved.

A Work Horse Like Any Other

First and foremost, know that these horses are true work horses. Richard B. Markell, DVM, volunteer treating veterinarian for the J.F. Shea Therapeutic Riding Center and its 35 therapy equids in San Juan Capistrano, Calif., says animals need to be physically fit to fill the role of therapeutic riding horse. 

“The old theory was that if a horse was old and broken down and lame and couldn’t do anything, we could put people with disabilities on it and walk it around in a circle,” he says. “But one of our directions at the Shea Center has been to recognize that these horses are working animals. They have a job to do. And they need to be sound and healthy to do it.”

Markell compares these horses to those he sees as a U.S. Olympic Team veterinarian and as the owner of a private practice treating elite show jumpers and hunters, Ranch & Coast Equine Practice, in Encinitas. “The Shea horses are on preventive care that is exactly the same as my multimillion-dollar Olympic horses,” he says. “A horse is a horse!”

And although not all therapy horses need an intense preventive care program, Markell says they should at least benefit from the kind of veterinary care and management you would provide for any working horse. And just as importantly, the therapy center should partner with a qualified equine veterinarian. 

A High-Stress Environment

Tina and Elliot’s job specifics—like those of any other horse in the therapy business—include exposure to “spooky” things. Wheelchairs, machines that lift riders on and off horses, screaming, loud voices, sudden arm and leg movements, mane- and tail-pulling, and unintentional hitting with curry combs and hoof picks are all routine. This excitement and potential chaos could put some horses into states of extreme stress or even panic, says Hélène Casal, MSc, researcher at the Faculty of Sports Science at the University of Poitiers, France, and at the Center for Image Analysis and Sports Performance (CAIPS), in Vouneuil-sous-Biard, France. A rehabilitation therapy engineer specializing in hippotherapy, Casal runs her own program on the grounds of a “normal” riding school, the Centre Equestre Grand Poitiers, in Mignaloux-Beauvoir, France.

“You have to choose horses that are, by nature, not easily stressed,” says Casal. “Once you have those horses, you have to prepare them for their job with excellent training. This is critical not only for the horse’s health and well-being, but also for its safety and that of the rider and handler.” 

The more fit the horses are, the fewer (physical) problems we will see.

Dr. Richard Markell

A Balancing Act 

One of the biggest challenges therapy horses face is rider imbalance, says Akihiro Matsuura, PhD, lecturer in the department of animal science at the Kitasato University School of Veterinary Medicine in Aomori, Japan. “Balance is an accepted problem with many disabled riders,” he says. “An inability to coordinate their movements with the movement of the horse is a further difficulty. An unbalanced rider is regarded in the horse world as ‘riding heavy.’

What this means for the horse is fatigue and discomfort, particularly in his back muscles. To compensate for this problem, CAIPS director François Durand, PhD, and his colleagues developed a special seat that attaches to the saddle to help keep riders stable. Winner of the Innovation Award at France’s 2012 Salon du Cheval, the patented “Hippolib” seat is the result of six years of biomechanical research. It adapts to all English saddles and all riders.

Casal and her colleagues studied and validated the inventor’s scientific claims for the seat in work she presented at the 2013 Equine Research Day in Paris. “With the exception of riders with severe handicaps, this stability seat appears to provide benefits to the practice of equitation,” she said. “We observed improved posture in those with significant disabilities and relaxation in those with moderate disabilities, with improved riding scores at the trot and an improved emotional state of the riders.”

While she determined that the rider becomes more stable and relaxed, she has yet to prove that the seat makes the horse more comfortable or relaxed—a project she says she’ll pursue in the very near future. But anecdotal evidence from her work has “entirely convinced” her that horses feel better when imbalanced patients ride in the Hippolib. 

“Repositioning and stabilizing the rider limits the impact on the horse’s back,” she explains. “The pressure from the rider’s weight is better distributed across the saddle, as it would be for an able-bodied rider. And when the person is stabilized, there is much less movement of the center of gravity, which can be very bothersome for the horse.”

Finding the Right Match

Rider weight can pose another challenge for therapy horses’ health, says Matsuura. Some disabled patients lead relatively sedentary lives, he says, and this can result in increased body weight. 

In recent research using therapy horses, Matsuura determined that an average horse should not carry more than 29% of his body weight. This calculation includes the rider’s clothing and the equipment—saddles, bridles, special tack—the horse wears. Certain breeds might be able to handle higher or lower percentages, but the 29% rule appears valid for many breeds, he says.

In practice, this means reserving sturdier horses—like stout 1,200-pound Elliot—for heavier riders. But this doesn’t mean all therapy horses must be big and broad. Different therapies and patients require different types of horses, says Casal. For instance, she says, riders with contracted or spastic muscles often are more comfortable seated on narrow horses. And horses with a lot of hindquarter engagement can create too much hip movement for some riders. Finding the right horse for each patient means therapy programs should ideally offer a good variety of mounts.

Variety is the Spice of Life

For Jean-Luc Aniorte, manager of the Poneys d’Enfer hippotherapy program, where Tina and Elliot work, getting the horses out of the therapy arena several times a week is critical to their well-being. He easily found willing volunteers to ride the horses out on the weekends. “They have to be able to clear their minds and think about other things,” he says of the horses. 

And the researchers agree. “To encourage intellectual curiosity, trekking (trail riding) may be good for therapy horses,” says Matsuura. Markell says able-bodied riders regularly take all the Shea Center horses to the dressage ring and out on the open trail. And in Casal’s stables, all the therapy horses are also used in “regular” riding classes as lesson horses. 

“Being in constant contact with people who have unpredictable behavior can be very stressful for the horses,” she says. “A change of scene for these horses is important for their stress levels, their morale, and their training levels.”

The change also helps keep them physically fit. “To maintain the condition of therapy horses, advanced riders should ride and train them,” Matsuura says.

“These horses absolutely need regular fitness programs,” Markell adds. “The more fit the horses are, the fewer (physical) problems we will see.”

Give Them a Break

Sometimes, just like any other worker, these horses need a break from riding altogether. A short vacation can recharge and prepare them to handle the stress and repetition of more therapeutic work with a good attitude. 

The Shea horses take two weeks off at Christmas, says Markell. Casal’s equine team takes about a month to relax over the summer. And Tina and Elliot head out of the city and into a lush countryside pasture from early July to late August.

But a full vacation might not suit all horses, says Markell. Because donated therapy horses do sometimes come with a medical history, caretakers must consider their individual needs. “We have a very good mare in our program with a history of mild osteoarthritis in her back,” he says. “We’ve discovered that regular exercise keeps her comfortable. So during the Christmas break, she continues dressage work under staff riders.” 

Donating a Horse for Therapy

Donating a horse for therapy can be one of the most rewarding decisions you make, says Richard Markell, DVM, volunteer treating veterinarian for the J.F. Shea Therapeutic Riding Center, in San Juan Capistrano, Calif. He cares for the facility’s 35 therapy equids and explains it’s “the sense of being part of something of true meaning (that) is so remarkable.” But take care when considering what horse you give and where. First, do some research and check with a local veterinarian to make sure the charity is a legitimate one, Markell says. Then ensure the horse you’re donating is healthy and sound, even if it might have a minor medical history. “We have a relatively high standard of soundness,” Markell says. “We do accept pre-existing conditions, but we are very selective with regard to what conditions we choose.” Above all, don’t donate an old, retired, lame horse to therapy. “This is not a field for broken-down horses,” he says.

Christa Lesté-Lasserre

Repetitive Overuse Injuries

But despite our best efforts—good training, regular workouts, and preventive care—sometimes therapy horses get injured. Generally, they’re subject to just about any kind of injury that other riding horses can get—cuts, scrapes, bruises, etc., says Markell. And during their nontherapy-session workouts they can sustain the typical accident-related sport horse injuries. 

You might also find repetitive overuse injuries in therapy horses. Markell says these can stem from repeated low-level impact on certain muscles and tendons—mostly in the back and neck, but sometimes in the legs as well. These frequently result from repetitive movements under poorly balanced riders. 

How do you know if your therapy horse is developing such an injury? Behavior changes mostly, says Markell. If he suddenly starts nipping or doesn’t want to be groomed anymore, it might be time to consider a veterinary exam for pain.

Recognizing Limits

Given the hard work and the stressful situations inherent to therapeutic riding, it’s important to recognize when a horse has just had enough. Some horses might be cut out for therapeutic riding, but others might not. And if they’re not, the program’s manager needs to accept that the horse either needs a good break or might even need to leave the program.

“We donated my wife’s horse to the Shea Center because she seemed like an ideal candidate,” Markell said. “And for six months, she was great. But after that, she clearly wasn’t happy anymore. She became impatient and started nipping. It just wasn’t for her. It was surprising to us, but she actually flunked out of the program.”

Like any hard worker, a therapy horse deserves a good retirement. At 17 years old, the Icelandic, Tina, has finally left the Paris program for good. She’s now spending her days grazing in a large pasture, surrounded by herdmates, with an occasional trot under saddle into the forest. 

Take-Home Message

Therapy horses are hard-working animals with special personality traits that help make them good at what they do. Caretakers need to ensure these animals are physically fit for the job, along with providing ongoing nontherapy training that keeps them healthy, strong, and mentally sound. Good management and monitoring can help preserve these horses’ good health and welfare.

About the Author

Christa Lesté-Lasserre, MA

Christa Lesté-Lasserre is a freelance writer based in France. A native of Dallas, Texas, Lesté-Lasserre grew up riding Quarter Horses, Appaloosas, and Shetland Ponies. She holds a master’s degree in English, specializing in creative writing, from the University of Mississippi in Oxford and earned a bachelor's in journalism and creative writing with a minor in sciences from Baylor University in Waco, Texas. She currently keeps her two Trakehners at home near Paris. Follow Lesté-Lasserre on Twitter @christalestelas.

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