Walking, or gait, is a complex pattern of movement that gets us from one place to another. Our bodies are passengers on our lower limbs which consist of multiple joints and muscles. Did you know that selective control and modulation of 57 muscles in the lower limbs is required for controlled gait?
In addition to controlled muscle action, in order for us to walk in an efficient and coordinated manner, several additional prerequisites are required. We need range of motion in the soft tissue to allow the limb to move forward; we need alignment of the body segments to keep our center of mass over our base of support. We need strength in each muscle as it is required to activate and hold. We need mobility in the joints of the ankle and foot which provide a rocker to move the body forward and also provide shock absorption as we step.
All of these things happen within our musculo-skeletal system as we walk, and yet we are not conscious of them. The movements are automatic and efficient, unless we have a disruption in any of those prerequisite factors. A disruption such as those we often see in people with cerebral palsy, or low muscle tone, or hemiplegia, to name a few.
If there is insufficient range of motion to gain full hip or knee extension, one cannot completely straighten the knee to make heel contact during an initial step. Immobility in the heel cord limits the ankle’s ability to move within full range and propel the lower leg over the foot. Weakness in the musculature might mean one cannot sustain weight on one limb long enough to progress the opposite limb forward.
Additional factors that affect gait include functional sensory systems, balance responses, and motor learning that enable us to activate our muscles in response to and in anticipation of environmental stimuli.
Physical therapists have an enormous amount of expertise in the normal development of gait and are able to analyze the components of movement to determine treatment plans.
How can Hippotherapy help?
Hippotherapy is an adjunct form of therapy that can support the gait-oriented goals of the physical therapist. The movement of the horse impacts the movement of the rider in a manner that is similar to the gait cycle. EMG studies have shown that riding activates the muscles in a sequence similar to muscular activation during walking. However, the impact of hippotherapy goes beyond this.
Hippotherapy provides a multi-system impact on the rider. The position on the horse relaxes tight muscles in the lower extremities, while the constant three-dimensional movement requires an instant and continuous response from the rider causing an increase in strength and control over time. The horse is moving through space, which alerts the visual and vestibular systems which are closely tied to posture and movement. Additionally, the proprioceptive, tactile, and kinesthetic systems are activated, all of which help improve awareness of body position in space and assist in functional motor responses.
Isn’t it amazing that one horse can do all of that? Perhaps the primary influence of the horse is to create a fun and engaging experience for the rider. Fun and meaningful activities are known to have more longlasting influence on learning, including motor learning.
We see better posture, better standing, and better walking after hippotherapy.
In order to maximize it’s impact, hippotherapy is and should be a part of a comprehensive therapy program including physical and occupational therapy. At Exceptional Equestrians we are beginning to collect objective data on the impact of hippotherapy on gait using our gait analysis system.
Lisa Kafka, OTR, HPCS
Diane McInnis, PT