Which condition is explicitly listed as a contraindication due to potential spinal instability?

• A. Asthma
• B. Normal blood pressure
• C. Seasonal allergies
• D. Atlantoaxial instability with significant displacement (greater than 4 mm for a child)

Answer: (D)

The key idea is spinal stability during therapy. Atlantoaxial instability means the C1-C2 region of the neck is unusually mobile or misaligned, and in children a displacement greater than 4 mm is a clear red flag. During hippotherapy, the horse’s gait creates dynamic, multi-directional forces that move the spine through flexion, extension, and rotation. If the neck’s upper segment is unstable, those forces can worsen the subluxation and potentially compress the spinal cord, leading to serious injury. That’s why this specific condition with measurable displacement is explicitly listed as a contraindication.

The other options don’t involve instability of the cervical spine. Asthma, normal blood pressure, and seasonal allergies are health considerations for therapy planning in general, but they don’t indicate a risk of spinal injury from the dynamic movements of hippotherapy.