We systematically reviewed the short-term effects of hippotherapy and therapeutic horseback riding (THR) on lower-limb muscle spasticity in children with cerebral palsy (CP).PubMed, EMBASE, Cochrane Library, and Google Scholar databases were searched for relevant quantitative studies. Treatment effects were coded using the Ashworth scale (AS) or modified Ashworth scale (MAS) in pre- and posttreatment evaluations. Of the 73 studies identified initially, 7 met the inclusion criteria.Treatment was associated with positive effects on lower-limb muscle spasticity, as supported by the AS or MAS scores. However, repeated trials did not show a statistically significant difference from a single trial (Q = 2.95, P = .086).Hippotherapy and THR can be used to treat lower-limb muscle spasticity in children with CP. However, repeated sessions did not show a better effect in reducing spasticity.This is the first meta-analysis to confirm that hippotherapy or THR can reduce lower-limb muscle spasticity in children with CP in the short term, but long-term effects on function still require further studies.