Amy Tomasheski has always loved horses. She began riding as a child and graduated to competitive riding in her teens.

When the 41-year-old, who lives in Harvard, Illinois, was diagnosed with relapsing-remitting multiple sclerosis (MS) in 2005, she was surprised when her care team mentioned working with a horse as part of her therapy for the condition.

“We were going over treatment options, and when they mentioned it I looked at them and said, ‘I’m already doing it,’” she recalls. “We just decided that I could keep doing what I was doing.”

While Tomasheski rides on her own, horseback riding is being used more and more often in rehabilitation settings as part of a treatment plan for a variety neurological disorders, including MS.

The practice — which is also known as equine-assisted therapy or hippotherapy — takes advantage of “equine movement to engage sensory, neuromotor, and cognitive systems to achieve functional outcomes,” according to the American Hippotherapy Association (AHA), an organization of practitioners.

Balance and Core Strength

For those with MS who can engage in hippotherapy safely, it has been found to provide improvements in balance, although most studies of hippotherapy have been small. A systematic review of studies published in September 2010 in the European Journal of Physical and Rehabilitation Medicine concluded that hippotherapy has a positive effect on balance in people with MS and has the added benefit of improving quality of life.

A more recent study, published in October 2015 in the journal Physiotherapy Theory and Practice, found that three people with MS who engaged in horseback riding twice a week for a six-week period, under the supervision of rehabilitation therapists, showed improvements in posture control, gait, and balance.

“Senses help map our motor responses, and we’ve found that by having people with MS get on a horse and move through space, perhaps at a faster pace than they can walk normally, we can effectively re-map and enhance their motor responses,” says Debbie Silkwood-Sherer, the director of the doctoral program in physical therapy at Central Michigan University in Mount Pleasant and a physical therapist who uses hippotherapy in her practice.

“Plus, the horse’s movement forces the rider to use his muscles to maintain balance, which strengthens the core. Typically, when people think about hippotherapy, they think about it in connection to children with movement disorders. But we’ve seen incredible benefits for adults with diseases like MS as well,” Silkwood-Sherer says.

Growing Acceptance Among Neurologists

Those benefits, says the AHA's executive director, Jacqueline Tiley, are why more and more neurologists who treat people with MS are turning to equine-assisted therapy.

The AHA provides a directory of member therapists (typically occupational and physical therapists who are certified in hippotherapy technique) in the United States, by state. Many of them practice the approach in their own clinics or at so-called therapeutic riding centers, which are stables with horses that have been trained as therapy animals. These facilities also provide ramps and lifts to assist people with mobility issues in getting on and off the horse, and they also typically offer “sidewalkers,” assistants who are there to provide support when needed.

Hippotherapy is effective, says Silkwood-Sherer, because it enables therapists to incorporate activities that they simply can’t replicate in the clinic. For example, Silkwood-Sherer says she has had her MS patients ride with their eyes closed to “engage their other senses in balance” and has even had patients carry weights in their hands while riding. She has also played catch with her patients while they are on horseback.

“That activity forces them to maintain their balance while moving,” she explains. “We call that dynamic balance, and we find that as your dynamic balance improves, your static balance goes off the charts.”

Is Hippotherapy Right for You?

Although practitioners such as Silkwood-Sherer recommend that people with MS interested incorporating equine movement into their treatment consult their neurologists first, she admits that not all physicians are as open to the approach as Tomasheski’s were.

“You may have to do your own research, and if so, the AHA website is probably the best place to start,” she says.

It’s still a good idea to check with your doctor to make sure you are healthy enough to use — and benefit from — hippotherapy. Silkwood-Sherer says people who have advanced or severe stages of MS, or who have gained too much excess weight, may not be a good fit for the approach.

People just starting out with hippotherapy also need to educate themselves regarding the potential risks and appropriate precautions to take, Tiley notes. Although Silkwood-Sherer describes the therapy horses as “as safe as you’ll find,” they are “still horses,” she adds, and may do “horse things,” such as jump or bolt when startled.

Tomasheski says she has fallen a couple of times since her diagnosis, but has since purchased “grippier gloves and full-seat riding britches” to improve stability.

Pleasure, Relaxation … and Therapy

Horseback-riding may be a lifelong love for Tomasheski — she still rides competitively, albeit at a slower pace — but she feels strongly that everyone with MS who is healthy enough to try it can benefit from hippotherapy.

“It is a hobby that has always given me pleasure and helped me relax, but I find that I seek it out more since my diagnosis because it helps relieve stress,” says Tomasheski, who volunteers at a therapeutic riding center as well.

“Before it was just a hobby; now it’s an essential part of my therapy. Horses are living, breathing animals, and they can sense fear and emotion and are so quiet, sweet, and kind. These therapy animals in particular understand their jobs and want to care for us. Feeling that connection with the horse is really a key part of why it’s been so effective for me,” she says.