The most obvious risk of hippotherapy and therapeutic horseback riding is falling from the horse. People with MS who are experiencing a significant exacerbation should probably avoid hippotherapy because they may be especially unstable. Also, riding may not be possible for people with difficulty sitting, decreased head control, and severe muscle stiffness or spas-ticity. People with severe fatigue or symptoms worsened by heat should be cautious about riding in hot weather. The American Hippotherapy Association lists a number of other conditions that should preclude hippotherapy, including severe osteoporosis, bone fractures, herniated disks, instability of the spine, severe arthritis, the use of anticoagulant medication, wounds or sores on weight-bearing surfaces, and seizures. The Association also recommends that therapy be done cautiously with some conditions, including diabetes, hip joint abnormalities, obesity, mild or moderate osteoporosis, allergies to dust or horsehair, heart disease, incontinence, and recent surgery.
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