Tandem or double riding in rehabilitation: a practice that deserves reflection.

Throughout the history of Equine-Assisted Services , many practices have emerged in response to the challenges faced by professionals.

Some remain relevant today. Others have been transformed as we have expanded our practical knowledge combined with science, because, to ensure that a treatment or intervention is safe, the healthcare field uses Evidence-Based Practice (EBP) .

From this perspective, we observe that practices in the field of neurofunctional rehabilitation have evolved significantly overall, and today we have knowledge about which interventions have supporting evidence and which do not.

See, for example, the article published by Novak et al (2020) which points out which practices are evidence-based and which are not for children and adolescents with cerebral palsy. This article makes it clear how science can be of great value in bringing clarity to our practice, allowing us to discard methods and techniques that no longer make sense and helping us to strengthen our clinical reasoning for responsible and ethical healthcare practice.

It is important to emphasize that in this article, the Hippotherapy method appears as an intervention with evidence for this population for motor outcomes; in other words, it is a green light for professionals who work in partnership with horses for rehabilitation purposes.

But it wasn't always like this. The rehabilitation practices used in hippotherapy years ago were based on more superficial knowledge and relied on more intuitive and experimental interventions.

But thanks to advances in science, such techniques and interventions have begun to be tested, and today, advanced knowledge exists regarding:

• neuroscience

• biodynamic horse-client unit during riding

• equine well-being

They made interventions involving horses more effective and validated.

This entire process is part of the evolution of any field that seeks to operate with quality.

Ultimately, good practices are not defined solely by accumulated experience, but also by our willingness to review our decisions in light of available scientific evidence.

It is in this context that we would like to propose a reflection on a practice still present in many centers: tandem or double riding.

And to invite you to reflect on the decisions that precede this choice.

Before deciding, it's worth asking yourself a few questions.

Double mounting is often used in different clinical situations.

When the client has difficulty maintaining balance and postural control, especially while seated. When they have difficulty modulating muscle tone. Or, when the professional wishes to perform certain manipulations or facilitations during the intervention.

These are decisions that typically stem from clinical experience and the desire to offer safety and better conditions for the development of the person being assisted.

But perhaps the most important question is not:

How can we keep this client on horseback?

Perhaps the question is different:

Is double riding really the best strategy to achieve the objectives of this intervention?

Or even:

What decisions need to be made and what reflections need to be made before we conclude that this is the most effective alternative?

Maintaining a posture or promoting motor learning?

Perhaps one of the greatest reflections on double riding lies in how we understand the purpose of the intervention.

In many cases, there is a concern to keep the person being assisted aligned ("straight") throughout the entire session. Whenever they lose their balance, lean forward, or show instability, our tendency is to immediately correct their posture or offer more support so that they remain seated "correctly."

But is that, in fact, the goal of neurofunctional rehabilitation in this case?

Today we understand that postural control in horses is not learned simply by someone holding the client's body in the most aligned way possible.

It is built when the participant experiences motor challenges gradually, experiences imbalances, organizes responses, and thus learns to control their body and coordinate movements.

It is precisely in this process that the three-dimensional movement of the intervention equine assumes a fundamental role.

Each oscillation produced by the horse's movement offers opportunities for the nervous system to organize increasingly efficient motor responses.

In other words, intervention doesn't happen despite the imbalances. Often, it happens precisely because of them.

And that doesn't mean exposing the client to unnecessary risks.

This means understanding that offering support is different from replacing your active participation in building motor skills.

Movement as a central element of the intervention.

The horse's movement is the main element of the therapeutic approach in rehabilitation, but it is necessary to understand the biomechanics of the animal's movement in an applied way, that is, to understand how the biodynamic horse-client system works and how we can intentionally manipulate the horse's movement for functional gains.

Therefore, any decision that alters this trend deserves attention.

What leads a client who uses a wheelchair with trunk and head support, and who can only maintain a seated posture with significant assistance, to transition to a seated position on a horse with minimal assistance, without being a tandem rider, thus receiving the stimuli needed for their rehabilitation?

When the decision is made not to use double mounting, several points and understandings must be considered through clinical reasoning to ensure the intervention is successful:

• The forces (vectors) caused by the horse's movement cancel each other out during the animal's walk, therefore it is easier for the client to balance with the movement rather than with the animal standing.

• The gait used is the walk, due to its symmetrical and rolling nature;

• Postural alignment comes with time through adaptive responses and motor learning, not because the therapist keeps the person in that position at all costs;

• Manipulating the horse's movement so that it walks at a low frequency (an average of 32 to 40 strides per minute) and with a straightness;

• Keeping the client's center of gravity as aligned as possible with that of the horse helps the animal produce a more fluid and harmonious movement;

• Performing holds and positioning techniques using key points to keep the person assisted in a horse-like position without significant effort on the part of the therapist;

• Use of the interface equipment that best contributes to the points mentioned above, which in this case is the saddle.

  
  

The points mentioned above take into account that the person assisted will be in a seated, facing forward position, which raises an important question. Does it make sense to avoid a tandem mount and allow the person to lie down on the horse?

The seated position facing forward on the horse already has evidence for motor outcomes in these rehabilitation cases, unlike the supine and prone positions.

So, if you don't yet have in-depth knowledge of what has been listed above, consider whether it's worthwhile to change your intervention format.

Every professional decision should also involve this question: am I qualified and knowledgeable about the current available evidence?

It's not about changing your intervention because some entity or professional pointed out that double riding is no longer considered good practice in rehabilitation; it's about carrying out your intervention responsibly and ethically, according to the knowledge you have up to this point.

The equine welfare also needs to be part of this decision.

In recent years, various studies have shown that increasing the load on the horse's back, and having the weight of a person sitting further back on its back, outside the rib cage, alters its biomechanics and causes the animal to use accessory muscles and compensate for movements, which impairs the quality of the intervention and causes harm to the horse being treated (Lima et al, 2026) .

This leads us to an important reflection.

If we aim to offer the client a quality movement experience, we need to consider how the presence of a second person can modify the primary stimulus used during the intervention.

When discussing tandem riding, we cannot only look at the person assisted.

We also need to look at the equine intervention program.

In most situations, the therapist remains seated on the posterior region of the animal's back, increasing the load supported by the animal.

Today we know that factors such as weight, load distribution, equipment used, and harness adjustment directly influence the comfort, biomechanics, and well-being of the horse.

If we advocate for ethical practice, we need to recognize that the quality of the intervention and equine welfare go hand in hand.

It is not possible to separate one from the other.

Before the double ride, other decisions need to be made.

Perhaps the main point of reflection is not about the double riding itself.

But above all, that's what should be evaluated before it becomes the first option.

Are we using the most suitable horse for that client?

Does your movement pattern meet the intervention goals?

Does its height make it easy to mount and offer safety?

Are we using the most appropriate equipment to promote functional positioning?

Does the harnessing technique allow the client to organize their own postural adjustments?

Is there another intervention strategy capable of achieving the same goals without significantly altering the horse's movement?

These questions are part of clinical reasoning.

And perhaps they are more important than simply answering whether or not a double mount should be used.

An area that evolves also revisits its practices.

The field of Equine-Assisted Services has evolved significantly in recent decades.

Today we have a better understanding of human development.

We learned more about motor learning.

We produced more research.

We have also significantly expanded our knowledge of equine behavior, biomechanics, and welfare.

This advancement invites us to revisit practices that, for a long time, were part of the routine of many centers.

Not because they were necessarily wrong.

But that's because we know more today than we did yesterday.

A field committed to science is not afraid to review its practices. On the contrary, it understands that evolving means continuing to ask questions.

Perhaps, when faced with a double mount, the most important question is not:

"Can we do it?"

Yes:

"After evaluating the person assisted, the horse, the objectives of the intervention, the available equipment, and all possible alternatives, is this still the best decision?"

At ABRE, we believe that quality decisions arise from the integration of scientific knowledge, clinical reasoning, and respect for intervention horses.

Rather than defending or condemning practices, our commitment is to stimulate reflection that contributes to increasingly safe, ethical, evidence-based interventions that are committed to both the development of people and the welfare of the horses that walk alongside us.