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Animals : an open access journal from MDPI2025; 15(17); 2587; doi: 10.3390/ani15172587

Hippotherapy in the Treatment of CMD and Bruxism in Dentistry.

Abstract: Dysfunctions and disorders of the craniomandibular system are accompanied by pathophysiological changes of muscle groups in the throat/neck and facial area, e.g., pain in the jaw and muscles of mastication and disturbance of occlusion, leading to teeth injury (loss of dental hard tissue, fractures/sensibility disorders, etc.). For muscular dysfunctions, even in the context of psychosomatic disorders and chronic stress, hippotherapy is particularly suitable, since it helps actively to relieve muscle tensions. In the current project we combined hippotherapy with progressive muscle relaxation (PMR) to achieve a synergistic effect. The horses used for therapy (two mares and five geldings between seven and twenty-one years old) were especially suitable because of their calm temperament. In two cases, trained therapy horses were used; in five other cases, the patients used their own horses, which were not specially trained. Right from the beginning, the project was accompanied by veterinary support. Conditions of horse keeping (active stable, same-sex groups, no boxes) were assessed as well as the horses themselves prior to, during, and after each therapy unit. In patients, cortisol, as a quantifiable parameter for stress, was measured before and after each therapy unit. From before the start until the end of each therapy unit of 15 min, the heart rate variability (HRV) of both patients and horses was registered continuously and synchronously. In addition, the behavior of the horses was monitored and recorded on video by an experienced coach and a veterinarian. The stress load during the tension phases in the therapy units was low, perceivable in the horses lifting their heads and a slightly shortened stride length. Likewise, the horses reflected the patients' relaxation phases, so that at the end of the units the horses were physically and psychically relaxed, too, noticeable by lowering their necks, free ear movement, and a decreasing heart frequency (HF). Altogether, the horses benefited from the treatment, too. Obvious stress signs like unrest, head tossing, tail swishing, or tense facial expressions were not noticed at any time. Twenty jumpers served as a control group in different situations (training, tournament, and leisure riding).
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Publication Date: 2025-09-03 PubMed ID: 40941382PubMed Central: PMC12427267DOI: 10.3390/ani15172587Google Scholar: Lookup
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Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

Hippotherapy combined with progressive muscle relaxation (PMR) was explored as a treatment for craniomandibular dysfunction (CMD) and bruxism in dentistry, focusing on relieving muscle tension and reducing stress in patients, while also monitoring effects on therapy horses involved.

Background and Purpose

  • Dysfunctions of the craniomandibular system (CMS) can cause muscle pain in the throat, neck, and facial areas, leading to problems such as jaw pain, disturbed bite (occlusion), and damage to teeth (wear, fractures, sensitivity).
  • These muscle dysfunctions may arise or be worsened by psychosomatic issues and chronic stress.
  • Hippotherapy, which involves therapeutic horseback riding, is known to help relieve muscle tension, making it suitable for addressing these CMS-related muscular problems.
  • The current study combined hippotherapy with progressive muscle relaxation (PMR) to maximize the therapeutic effect for CMD and bruxism.

Methods and Study Design

  • The study involved therapy horses characterized by calm temperaments, comprising two mares and five geldings aged between 7 and 21 years.
  • Some patients used trained therapy horses, while others brought their own horses that were not specially trained, allowing assessment of different horse types.
  • Veterinary support was present throughout the project, ensuring the welfare of the horses during therapy sessions.
  • Parameters assessed related to both patients and horses included:
    • Patients’ cortisol levels, as a biological marker of stress, measured before and after 15-minute therapy units.
    • Heart rate variability (HRV) of both horses and patients, recorded continuously and synchronously during therapy, to track physiological stress and relaxation responses.
    • Behavioral observations of horses, recorded on video by an experienced coach and veterinarian, focusing on signs of stress or relaxation.
    • Conditions of horse keeping were evaluated to ensure a low-stress environment, involving active stabling with same-sex groups and no box stalls.
    • A control group of 20 jumpers was used to compare stress and behavior in various settings (training, tournaments, leisure riding).

Findings Related to Horses

  • Horses showed minimal stress during tension phases of therapy, indicated by subtle signs such as head lifting and slightly shortened stride length.
  • During patient relaxation phases, horses mirrored this state by relaxing physically and mentally, demonstrated by lowered necks, relaxed ear movement, and decreased heart rates.
  • Horses benefited from the therapy, exhibiting no overt stress behaviors such as head tossing, tail swishing, or tense facial expressions.
  • Overall, horses remained calm and appeared to gain from the treatment sessions, highlighting the importance of appropriate horse selection and welfare considerations in hippotherapy.

Findings Related to Patients

  • The combined hippotherapy and PMR approach contributed to muscle relaxation and stress relief in patients with CMD and bruxism.
  • Reduction in cortisol levels post-therapy suggested effective stress alleviation.
  • Continuous HRV monitoring supported physiological evidence of improved relaxation during therapy units.

Implications and Conclusions

  • The study supports hippotherapy, especially combined with PMR, as a promising non-invasive treatment for CMD and bruxism caused or aggravated by muscular tension and stress.
  • Therapy is effective not only in improving patient outcomes but also is well tolerated and even beneficial for therapy horses.
  • Ensuring suitable horse temperament, proper care conditions, and veterinary oversight is essential to maintain horse welfare during hippotherapy sessions.
  • Using patients’ own horses is feasible but should consider the horse’s temperament and training to optimize therapeutic benefits and animal welfare.
  • Future studies could expand patient numbers, explore long-term effects, and compare hippotherapy to other treatment modalities for CMD and bruxism.

Cite This Article

APA
Geibel MA, Kildal D, Geibel AM, Ott S. (2025). Hippotherapy in the Treatment of CMD and Bruxism in Dentistry. Animals (Basel), 15(17), 2587. https://doi.org/10.3390/ani15172587

Publication

Animals : an open access journal from MDPI
ISSN: 2076-2615
NlmUniqueID: 101635614
Country: Switzerland
Language: English
Volume: 15
Issue: 17
PII: 2587

Researcher Affiliations

Geibel, Margrit-Ann
  • Dento-Maxillofacial Radiology, Department of Maxillofacial Surgery, University Hospital Ulm, 89070 Ulm, Germany.
  • Department Gender-Specific Dentistry, Danube University, 3500 Krems an der Donau, Austria.
Kildal, Daniela
  • Department of Diagnostic and Interventional Radiology, University Hospital Ulm, 89070 Ulm, Germany.
  • Radiology, Upper Valais Hospital Center (SZO), Hôpital du Valais, 3900 Brig, Switzerland.
Geibel, Amina Maria
  • Department of General Pediatric Dentistry, University Center of Dentistry Basel, 4058 Basel, Switzerland.
Ott, Sibylle
  • i3R Center, Ulm University, 89081 Ulm, Germany.
  • Endocrinology and Physiology, University Ulm, 89081 Ulm, Germany.

Conflict of Interest Statement

The authors declare no conflicts of interest.

References

This article includes 47 references
  1. Hugger A, Lange M, Schindler HJ, Türp JC. Begriffsbestimmungen: Funktionsstörung, Dysfunktion, Craniomandibuläre Dysfunktion (CMD), Myoarthropathie des Kausystems (MAP). .
  2. . AWMF Leitlinie S3 Diagnosik und Behandlung des Bruxismus. 2019.
  3. De Leeuw R, Klasser GD, Reyes MR. Orofacial Pain, Guidelines for Assessment, Diagnosis, and Management. 7th ed. Quintessence Publishing Co. Limited; New Malden, UK: Surrey, UK: 2009.
  4. Deutsches Kuratorium für Therapeutisches Reiten, E.V. [(accessed on 1 July 2025)]. Available online: https://dkthr.de/
  5. Wahlund K, Nilsson IM, Larsson B. Treating temporomandibular disorders in adolescents: A randomized, controlled, sequential comparison of relaxation training and occlusal appliance therapy. J Oral Facial Pain Headache 2015;29:41–50.
    doi: 10.11607/ofph.1285pubmed: 25635959google scholar: lookup
  6. Jacobson E. Progressive Relaxation: A Physiological and Clinical Investigation of Muscular States and Their Significance in Psychology and Medical Practice. 1st ed. University of Chicago Press; Chicago, IL, USA: 1938.
  7. Torales J, O’Higgins M, Barrios I, Gonzalez I, Almirón M. An Overview of Jacobson’s Progressive Muscle Relaxation in Managing Anxiety. Rev Argent Clin Psicol 2020;XXIX:17–23.
    doi: 10.24205/03276716.2020.748google scholar: lookup
  8. . Stresshormon Verringert Knochenstabilität Bei Kindern. 2014.
  9. Shi L, Sánchez-Guijo A, Hartmann MF, Schönau E, Esche J, Wudy SA, Remer T. Higher glucocorticoid secretion in the physiological range is associated with lower bone strength at the proximal radius in healthy children: Importance of protein intake adjustment. J Bone Miner Res Off J Am Soc Bone Miner Res 2015;30:240–248.
    doi: 10.1002/jbmr.2347pubmed: 25196629google scholar: lookup
  10. . Dauerstress Behindert Die Knochenheilung Nach Brüchen. 2019.
  11. Haffner-Luntzer M, Foertsch S, Fischer V, Prystaz K, Tschaffon M, Mödinger Y, Bahney CS, Marcucio RS, Miclau T, Ignatius A. Chronic psychosocial stress compromises the immune response and endochondral ossification during bone fracture healing via β-AR signaling. Proc Natl Acad Sci USA 2019;116:8615–8622.
    doi: 10.1073/pnas.1819218116pmc: PMC6486758pubmed: 30948630google scholar: lookup
  12. Vashist SK, Schneider EM. Editorial: Depression: An Insight and Need for Personalized Psychological Stress Monitoring and Management. J Basic Appl Sci 2014;10:177–182.
    doi: 10.6000/1927-5129.2014.10.25google scholar: lookup
  13. Strahler J, Skoluda N, Kappert MB, Nater UM. Simultaneous measurement of salivary cortisol and alpha-amylase: Application and recommendations. Neurosci Biobehav Rev 2017;83:657–677.
    doi: 10.1016/j.neubiorev.2017.08.015pubmed: 28864234google scholar: lookup
  14. Hellhammer DH, Wüst S, Kudielka BM. Salivary cortisol as a biomarker in stress research. Psychoneuroendocrinology 2009;34:163–171.
    doi: 10.1016/j.psyneuen.2008.10.026pubmed: 19095358google scholar: lookup
  15. Pilger A, Haslacher H, Meyer BM, Lackner A, Nassan-Agha S, Nistler S, Stanglmaier C, Endler G, Mikulits A, Priemer I. Midday and nadir salivary cortisol appear superior to cortisol awakening response in burnout assessment and monitoring. Sci Rep 2018;8:9151.
    doi: 10.1038/s41598-018-27386-1pmc: PMC6002544pubmed: 29904183google scholar: lookup
  16. Wollschläger T. Normwerte der Herzfrequenzvariabilität: Was Bedeuten Sie für Ihre Gesundheit?. .
  17. Hughson R, Yamamoto Y, McCullough R, Sutton J, Reeves J. Sympathetic and parasympathetic indicators of heart rate control at altitude studied by spectral analysis. J. Appl. Physiol. 1994;77:2537–2542.
    doi: 10.1152/jappl.1994.77.6.2537pubmed: 7896588google scholar: lookup
  18. Chiu H.W, Kao T. A mathematical model for autonomic control of heart rate variation. IEEE Eng. Med. Biol. Mag. 2001;20:69–76.
    doi: 10.1109/51.917726pubmed: 11321722google scholar: lookup
  19. Hottenrott K, Hoos O, Esperer H.D. Herzfrequenzvariabilität: Gesundheitsförderung, Trainingssteuerung, Biofeedback. Satellitensymposium: Training und Therapie in Künstlicher Höhe. Volume 214 Schriftenreihe der Deutschen Vereinigung für Sportwissenschaft Band; Feldhaus Verlag; Hamburg, Germany: 2011.
  20. Malik M, Bigger J.T, Camm A.J, Kleiger R.E, Malliani A, Moss A.J, Schwartz P.J. Heart rate variability: Standards of measurement, physiological interpretation, and clinical use. Eur. Heart J. 1996;17:354–381.
    doi: 10.1093/oxfordjournals.eurheartj.a014868pubmed: 8737210google scholar: lookup
  21. Kleiger R.E, Miller J.P, Bigger J.T, Moss A.J. Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. Am. J. Cardiol. 1987;59:256–262.
    doi: 10.1016/0002-9149(87)90795-8pubmed: 3812275google scholar: lookup
  22. Immanuel S, Teferra M.N, Baumert M, Bidargaddi N. Heart Rate Variability for Evaluating Psychological Stress Changes in Healthy Adults: A Scoping Review. Neuropsychobiology 2023;82:187–202.
    doi: 10.1159/000530376pmc: PMC10614455pubmed: 37290411google scholar: lookup
  23. . Herzfrequenzvariabilität: Was Sie Bedeutet und Wie Sie Ihre Werte Verbessern. .
  24. Miller K.F.. Kennen Sie Die Normalwerte Ihres Pferdes—Wie Man Die Wichtigsten Vitalwerte Erfasst, Misst und Verfolgt. .
  25. Uhlendorf F. Vergleichende Untersuchung Zu elektrokardiographischen Techniken und der Analyse der Herzfrequenzvariabilität Mit Dem Langzeit-EKG Bei Warmblutpferden. Dissertation Hannover 2009 URN (urn:nbn:de:gbv:95-97168).
  26. Löllgen H. Serie: Neue Methoden Der Kardialen Funktionsdiagnostik—Herzfrequenzvariabilität. Deutsches Ärzteblatt 1999, Ausgabe: 31-32/1999.
  27. Naber A, Kreuzer L, Zink R, Millesi E, Palme R, Hediger K, Glenk L.M. Heart rate, heart rate variability and salivary cortisol as indicators of arousal and synchrony in clients with intellectual disability, horses and therapist during equine-assisted interventions. Pet Behav. Sci. 2019;7:17–23.
    doi: 10.21071/pbs.v0i7.11801google scholar: lookup
  28. Hödl S. Transportstress Bei Pferden, Einfluss von wiederholten Transporten Auf Der Strasse Auf Die Belastung Von Transportunerfahrenen Pferden. Masterarbeit. 2010.
  29. Baevsky R.M, Chernikova A.G. Heart Rate Variability Analysis: Physiological Foundations and Main Methods. Cardiometry 2017;10:66–76.
    doi: 10.12710/cardiometry.2017.10.6676google scholar: lookup
  30. . Methodical Recommendations Use KARDiVAR System for Determination of the Stress Level and Estimation of the Body Adaptability. Standards of Measurements and Physiological Interpretation.. 2009.
  31. Wundrak S., Paul J., Ulrici J., Hell E., Geibel M.A., Bernhardt P., Rottbauer W., Rasche V.. A self-gating method for time-resolved imaging of nonuniform motion. Magn. Reson. Med. 2016;76:919–925.
    doi: 10.1002/mrm.26000pubmed: 26451753google scholar: lookup
  32. Kaiser L., Heleski C.R., Siegford J., Smith K.A.. Stress-related behaviors among horses used in a therapeutic riding program. J. Am. Vet. Med. Assoc. 2006;228:39–45.
    doi: 10.2460/javma.228.1.39pubmed: 16426164google scholar: lookup
  33. Brelsford V.L., Dimolareva M., Gee N.R., Meints K.. Best Practice Standards in Animal-Assisted Interventions: How the LEAD Risk Assessment Tool Can Help. Animals 2020;10:974.
    doi: 10.3390/ani10060974pmc: PMC7341237pubmed: 32503309google scholar: lookup
  34. McKinney C., Mueller M.K., Frank N.. Effects of Therapeutic Riding on Measures of Stress in Horses. J. Equine Vet. Sci. 2015;35:922–928.
    doi: 10.1016/j.jevs.2015.08.015google scholar: lookup
  35. Welsch U., Deller T. Lehrbuch Histologie. 3rd ed. Elsevier Verlag; Amsterdam, The Netherlands: 2010.
  36. Tarvainen M.P., Lipponen J., Niskanen J.-P., Ranta-Aho P.O.. Kubios HRV Software USER’S GUIDE. Nov, 2021.
  37. Gussgard A.M., Weese J.S., Hensten A., Jokstad A.. Dog-assisted therapy in the dental clinic: Part A-Hazards and assessment of potential risks to the health and safety of humans. Clin. Exp. Dent. Res. 2019;5:692–700.
    doi: 10.1002/cre2.240pmc: PMC6934338pubmed: 31890307google scholar: lookup
  38. Gussgard A.M., Carlstedt K., Meirik M.. Intraoral clinical examinations of pediatric patients with anticipatory anxiety and situational fear facilitated by therapy dog assistance: A pilot RCT. Clin. Exp. Dent. Res. 2023;9:122–133.
    doi: 10.1002/cre2.679pmc: PMC9932233pubmed: 36259429google scholar: lookup
  39. Geibel M.A.. Orale Medizin Band 1, Gender Dentistry Grundlagen und Konsequenzen für Den Zahnmedizinischen Alltag. Lehmanns Media; Berlin, Germany: 2021. pp. 203–214.
  40. Johnson R.A., Johnson P.J., Megarani D.V., Patel S.D., Yaglom H.D., Osterlind S., Grindler K., Vogelweid C.M., Parker T.M., Pascua C.K.. Horses Working in Therapeutic Riding Programs: Cortisol, Adrenocorticotropic Hormone, Glucose, and Behavior Stress Indicators. J. Equine Vet. Sci. 2017;57:77–85.
    doi: 10.1016/j.jevs.2017.05.006google scholar: lookup
  41. Malinowski K, Yee C, Tevlin JM, Birks EK, Durando MM, Pournajafi-Nazarloo H, Cavaiola AA, McKeever KH. The Effects of Equine Assisted Therapy on Plasma Cortisol and Oxytocin Concentrations and Heart Rate Variability in Horses and Measures of Symptoms of Post-Traumatic Stress Disorder in Veterans. J. Equine Vet. Sci. 2018;64:17–26.
    doi: 10.1016/j.jevs.2018.01.011pubmed: 30973147google scholar: lookup
  42. Ayala MD, Carrillo A, Iniesta P, Ferrer P. Pilot Study of the Influence of Equine Assisted Therapy on Physiological and Behavioral Parameters Related to Welfare of Horses and Patients. Animals 2021;11:3527.
    doi: 10.3390/ani11123527pmc: PMC8698107pubmed: 34944303google scholar: lookup
  43. Seery R, Wells D. An Exploratory Study into the Backgrounds and Perspectives of Equine-Assisted Service Practitioners. Animals 2024;14:347.
    doi: 10.3390/ani14020347pmc: PMC10812823pubmed: 38275806google scholar: lookup
  44. Fine AH, Beck AM, Zenithson N. The State of Animal-Assisted Interventions: Addressing the Contemporary Issues That Will Shape the Future. Int. J. Environ. Res. Public Health 2019;16:3997.
    doi: 10.3390/ijerph16203997pmc: PMC6843928pubmed: 31635430google scholar: lookup
  45. International Association of Human-Animal Interaction (IAHAIO) International Guidelines on Care, Training and Welfare Requirements for Equines in Equine-Assisted Services. Version 1, 2021 (17.12.24) [(accessed on 1 July 2025)]. Available online: https://iahaio.org.
  46. Serpell JA, Coppinger R, Fine AH, Peralta JM. Welfare considerations in therapy and assistance animals. In: Fine A.H., editor. Handbook on Animal-Assisted Therapy. Elsevier; Amsterdam, The Netherlands: 2010.
    doi: 10.1016/B978-0-12-381453-1.10023-6google scholar: lookup
  47. TVT, Tierärztliche Vereinigung Für Tierschutz. Nutzung Von Tieren Im Sozialen Einsatz, 131.9 Pferde. June 2012. [(accessed on 1 July 2025)]. Available online: https://www.tierschutz-tvt.de.

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