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Brilliant article discussing the benefits of Rider Physiotherapy written by Kate Fletcher.

How rider physiotherapy can also help our horses

As equestrians, it is not uncommon for us to regularly book our beloved horses in for regular physiotherapy sessions to ensure that they are in peak condition. Our own health and fitness, however, usually gets shunted to the bottom of the priority list. I know that I for one have historically prioritised the health and fitness of my horses above my own; but are we doing our horses an injustice by neglecting our own aches and pains? If we expect our horses to carry us, be that out for a gentle hack or over a cross-country course, do we not have an obligation to ensure that we consider our own balance, symmetry and fitness to make their life easier and to ensure that both our horse and ourselves, as a partnership, are performing as well as we can?

Equestrianism is a unique sport in that it involves two athletes, of vastly different morphology, required to move in harmony with each other. Itis also a physical activity, ergo the health and fitness of the rider will undoubtedly influence the performance and physical capacity of the other member of the partnership; the horse. An unbalanced rider will be unable to give clear and consistent aids to the horse and this can affect the horse’s ridden behaviour and force them to adapt their movement to account for the rider’s asymmetry, with conflict behaviour (for example bucking, kicking out, mouth gaping) seemingly to be strongly related to the presence of a rider¹. The inability of the horse to verbally communicate when they are in pain or struggling places vital responsibility on riders to ensure that welfare is enhanced and a positive human-horse relationship is promoted. Ensuring that both horse and rider are physically and psychologically prepared is critical to achieving this.

Unfortunately, however, there tends to be a lack of awareness of how such rider pain or crookedness can affect the horse’s own asymmetry with only 14% of riders reporting this as a concern², despite evidence that this will influence their capability and their horse’s ridden performance³ and impact on their horse’s locomotion⁴. Physical synchronisation between horse and rider is vital, with the movements of a rider’s hips and seat mirroring the horse’s leg movements and the horse able to detect human intentions, risking unintentional communication if riders are unaware of their own body symmetry, posture and correct movement⁵.

Being a good rider and communicating well with the horse requires balance, strength and control of one's body⁶. This is not a new concept,with the principles of classical horsemanship, outlined by Colonel Alois Podhajsky⁷,Director of the Spanish Riding School in Vienna, famously stating in the early 1970’sthat the rider’s ability to control themselves should be paramount before they endeavour to control their horse. Somewhere along the line, however, ‘control’ became about ever more aversive “quick-fix” devices, rather than about the rider looking introspectively at themselves and their own abilities.

Whilst a survey of Olympic equestrians found agreement that rider fitness had an impact on performance, only 56.9% considered themselves to be fit⁸. Trainers and judges often comment that riders are asymmetrical, “crooked” or “collapsed in the hip”, and there is agreement that compromised posture, stability and balance can have a detrimental effect on performance⁹. However this shouldn’t only be a concern for professional, elite riders with most amateur riders reportedly significantly weaker than amateurs in other sports¹º.

Professional riders report slightly higher prevalence of back pain than amateur riders¹¹ with a shocking 96% of international event riders competing while experiencing pain¹². Most riders report that this pain was in the neck, back or shoulders as well as other areas of the body². There also appears to be a significant correlation between gender and pain, with female riders more likely to experience pain. Elite riders suffering from pain might proceed with competing due to pressures from sponsors or owners and the need for success. However, pain is perceived to affect rider performance by increasing fatigue and anxiety, decreasing ability to concentrate and affecting both postural asymmetry and range of motion¹³.

Pain is not an uncommon experience amongst equestrians, potentially due to horse-riding being more dangerous than many sports including skiing, football and rugby resulting in one in five equestrians being seriously injured during their riding careers¹⁴ and horse-riding falls being the most common sporting injury¹⁴. Although, conversely, other studies have found that the prevalence of pain amongst riders appears to be no more common than within the general population¹⁵, the prevalence of back pain in particular appears to be very high amongst equestrians who both regularly ride and work with horses. Rider back pain is commonly associated with an ill-fitted saddle and stiff, stilted movement in the horse, highlighting the requirement for better education in identifying rider crookedness and poorly-fitting saddles¹⁶.

Whilst the majority of riders in pain reach for over-the-counter medication to attempt to alleviate symptoms¹², very few address the root cause with less than a fifth of Fédération Equestre Internationale (FEI) level riders investing in physiotherapy¹⁷ despite knowledge that it could improve their riding. Physiotherapy intervention and spinal stabilisation exercises are proven to help rider asymmetry and postural stability⁹ and reduce pain¹⁸. Improving spinal posture can protect the spine better, reducing the likelihood of injury¹⁹.

Horse-riding can actually be therapeutic for those in pain, both psychologically and by improving postural control²º. The majority of us are motivated to ride for pleasure but some riders also find it therapeutic²¹. An equine assisted therapy programme on 24 patients with debilitating back pain found that riding could produce positive consequences including decreased pain and increased awareness of the patient’s body, competence, emotion and environment²² but the impact of a rider in pain or unbalanced on the horse itself was not considered. However, use of both a gym ball and physiotherapy exercises for spinal health, alongside horse-riding, over a six-week period has been shown to be effective in improving back pain and balance ability with continuous exercise minimising the risk of recurrence and helping to both prevent and treat back pain²³.

So with physiotherapy proven to help address rider weakness, asymmetry, imbalance, poor posture and pain, not only can it potentially help us to be better riders but it can also help us to help our horses to be stronger and more balanced by not compromising their movement. The message is not to prioritise one side over the other, more that both horse and rider are worthy of investing in because the wellbeing of both, as a partnership, are inextricably interlinked. The same way we might consider the impact of saddle choice on a horse’s way of going, we should also consider the person sat in that saddle and whether they are sufficiently prepared for the activity in which they are engaging in.

Finding a physiotherapist who specialises in horse-riders and understands how the horse and rider work together, such as The Centered Rider, can help to identify appropriately targeted exercises and therapeutic interventions to strengthen not only the rider but also the relationship between them and their horse. With increased awareness of the horse-human relationship and the multiple factors affecting it, perhaps there will come a time when incorporating specialist physiotherapy into a rider’s toolkit is as commonplace as regular veterinary and farriery check-ups for the horse, whether you are a happy hacker or Olympic level. Achieving longer-term, proactive solutions to help both parties in the equestrian dyad surely makes much more sense than either ignoring our own health as a rider and not considering the impact that this has on our horses, or reaching for short-term, quick-fix measures that could compromise welfare and exacerbate existing problems.


¹Dyson S., Berger J., Ellis A., Mullard J. (2017). Can the presence of musculoskeletal pain be determined from the facial expressions of ridden horses (FEReq)? Journal of Veterinary Behavior: Clinical Applications and Research, 19, 78-89.

²Lewis, V., Dumbell, L. and Magnoni, F. (2018). A preliminary study to investigate the prevalence of pain in competitive showjumping equestrian athletes. Journal of physical fitness, medicine and treatment in sport, 4 (3). DOI: 10.19080/JPFMTS.2018.04.555637.

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MacKechnie-Guire, R., MacKechnie-Guire, E., Fairfax, V., Fisher, M., Hargreaves, S. and Pfau, T. (2020). The Effect That Induced Rider Asymmetry Has on Equine Locomotion and the Range of Motion of the Thoracolumbar Spine When Ridden in Rising Trot. Journal of Equine Veterinary Science, Vol 88, 102946, DOI:10.1016/j.jevs.2020.102946.

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⁹Nevison, C.M. and Timmis, M.A. (2013). The effect of physiotherapy intervention to the pelvic region of experienced riders on seated postural stability and the symmetry of pressure distribution to the saddle: A preliminary study. Journal of Veterinary Behavior, Vol 8 (4), 261-264, DOI:10.1016/j.jveb.2013.01.005.

¹ºHalliday E. and Randle H. (2013). The Horse and Rider Bodyweight Relationship Within The UK Horse Riding Population. Journal of Veterinary Behavior: Clinical Applications and Research, 8(2), 8-9.

¹¹Deckers, I., De Bruyne, C., Roussel, N.A., Truijen, S., Minguet, P., Lewis, V., Wilkins, C. and Van Breda, E. (2020). Assessing the sport-specific and functional characteristics of back pain in horse riders. Comparative Exercise Physiology: 0 (0), 1 – 10, DOI: 10.3920/CEP190075.

¹²Lewis, V. and Baldwin, K. (2018). A preliminary study to investigate the prevalence of pain in international event riders during competition, in the United Kingdom. Comparative Exercise Physiology, Vol 14 (3), 173-181(9), DOI: 10.3920/CEP180006.

¹³Lewis, V. and Kennerly, R. (2018). A preliminary study to investigate the prevalence of pain in elite dressage riders during competition in the United Kingdom. Comparative Exercise Physiology, Vo 13 (4), 259-263(5), DOI:10.3920/CEP170016.

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¹⁷Webb, H.J., Weston, J.F., Norman, E.J., Cogger, N.D.and Rogers, C.W.(2019). Experience, riding practices and training methods of Fédération Equestre Internationale (FEI: 80-160 km) level endurance horse rider-owner-trainers in New Zealand. Comparative Exercise Physiology, Vol 15 (2) 137-145(9), DOI: 0.3920/CEP180059.

¹⁸Abass, A. O., Alli, A., Olagbegi, O., Christie, C., and Bolarinde, S. (2020). Effects of an eight-week lumbar stabilization exercise programme on selected variables of patients with chronic low back pain. Bangladesh Journal of Medical Science, 19(3), 467-474. DOI:10.3329/bjms.v19i3.45864.

¹⁹Jauch, Y., Wallstabe, S., Sellenschloh, K., Rundt, D., Püschel, K., Morlock, M.M., Meenen, N.M. and Huber, G. (2015). Biomechanical modelling of impact-related fracture characteristics and injury patterns of the cervical spine associated with riding accidents. Clinical Biomechanics, Vol 30 (8), 795-801, DOI:10.1016/j.clinbiomech.2015.06.011.

²ºCollado-Mateo, D., Lavín-Pérez, A.M., Fuentes García, J.P., García-Gordillo, M.Á., and Villafaina, S. (2020). Effects of Equine-Assisted Therapies or Horse-Riding Simulators on Chronic Pain: A Systematic Review and Meta-Analysis. Medicina, 56, 444.

²¹ Davis D. (Ed) and Maurstad A. (Ed) (2016). The Meaning of Horses: Biosocial Encounters. London: Routledge,

²²Håkanson M, Möller M, Lindström I et al. (2009). The horse as the healer—A study of riding in patients with back pain. Journal of Bodywork and Movement Therapies, vol: 13 (1) pp: 43-52.

²³Choi, J., Kim, M., Kim, S., Son, B., Lee, S., Lee, Y., Jang, D., Je, H. and Kim, K. (2019). Effects of a Horse Riding Simulator, Gym-ball and McKenzie Exercises on Back Pain and Balance in Patients with Chronic Back Pain in Their 20s. Journal of the Korean Society of Physical Medicine, 14:117-126, DOI: 10.13066/kspm.2019.14.3.117.

Kate Fletcher, who has a Masters in Equine Behaviour, Performance and Training, runs Affective Equine (, an equine behaviour and welfare blog, and Welfare Aware (, an animal consultancy service.

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