Abstract
Hippotherapy is defined as the “use of the equine movement as a strategy by Physical Therapists, Occupational Therapists and Speech and Language Therapists to address impairment, functional limitations and disabilities in patients with neuromuscular dysfunction” (American Hippotherapy Association (A.H.A.), 2016). Hippotherapy has been used in paediatrics in rehabilitation of gait and movement. However evidence for the use of Hippotherapy as treatment in musculoskeletal disorders is limited due to the dearth of research. This study investigates the use of Hippotherapy as part of an integrated treatment programme to treat CLBP.
Objectives
This study examines the effect of a six week course of Hippotherapy on a patient with Chronic Low Back Pain (CLBP), with particular regard to pain, range of motion and disability.
Methodology
This single case study involves a 41 year old female patient with sedentary occupation. Safety and risk assessment were prioritised. The equine was chosen for suitability following rigorous assessment of conformation, temperament and training.
Treatment occurred once weekly (thirty minute session) and consisted of relaxation, breathing and stabilising exercises, and arm and trunk movements recruiting the core and maintaining balance. A follow-up assessment was conducted six weeks after the final treatment session in week 12.
The Visual Analogue Scale (VAS) was used to score pain pre- and post-treatment in weeks 1 and 6 and at the follow-up in week 12. The Modified Oswestry Disability Questionnaire and Modified Schober’s Index were scored and measured in weeks 1, 6 and 12.
Results
Results were consistent reduction of pain. Pain was reduced by 50%, and postural awareness was enhanced. Minor changes were observed in the range of motion, but there was no change in the Modified Oswestry Disability Scale.
Conclusions
This study indicates the potential benefit of Hippotherapy in a broader range of musculoskeletal conditions. Hippotherapy can be beneficial as part of a holistic approach to treatment of CLBP, encouraging activity and movement. Further studies are necessary, using 3-dimentional motion analysis, to establish exact movement attained in the patient spine relative to the movement of the horse. Electromyographic studies of the sequential muscle action of the patient in response to the equine motion are also considered necessary. The limitations of a single case study in evaluating a treatment strategy are recognised, and it is acknowledged that a randomised control trial would be necessary to fully establish the effectiveness of Hippotherapy in CLBP.
References
Angoules, A.G., Koukoulas, D., Balakatounis, K., Kapari, I., Matsouki, E. A review of the efficacy of Hippotherapy for the treatment of Muscloskeletal disorders. British Journal of Medicine & Medical Research, (2015) 8(4), pp. 289-297.
Goldmann, T., Vilimek, M., Kinematics of Human Spine During Hippotherapy. Computer Methods in Biomechanics and Biomedical Engineering, (2012) 15, pp. 203-205.
Ethical Approval
Ethical Approval was not required for this study by CSP. The patient was fully informed and signed informed consent. The patient has no intellectual disability and had expressed an interest in participating in this study.
The riding centre used in this study is approved by AIRE. The therapeutic team were fully trained to Riding for Disabled Ireland standards. The treatment was Physiotherapist led.
