Open Access Open Badges Research article

The influence of expectation on spinal manipulation induced hypoalgesia: An experimental study in normal subjects

Joel E Bialosky1*, Mark D Bishop1, Michael E Robinson2, Josh A Barabas1 and Steven Z George1*

Author Affiliations

1 University of Florida Department of Physical Therapy, Gainesville, Florida, USA

2 University of Florida Department of Clinical and Health Psychology, Gainesville, Florida, USA

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BMC Musculoskeletal Disorders 2008, 9:19  doi:10.1186/1471-2474-9-19

Published: 11 February 2008



The mechanisms thorough which spinal manipulative therapy (SMT) exerts clinical effects are not established. A prior study has suggested a dorsal horn modulated effect; however, the role of subject expectation was not considered. The purpose of the current study was to determine the effect of subject expectation on hypoalgesia associated with SMT.


Sixty healthy subjects agreed to participate and underwent quantitative sensory testing (QST) to their leg and low back. Next, participants were randomly assigned to receive a positive, negative, or neutral expectation instructional set regarding the effects of a specific SMT technique on pain perception. Following the instructional set, all subjects received SMT and underwent repeat QST.


No interaction (p = 0.38) between group assignment and pain response was present in the lower extremity following SMT; however, a main effect (p < 0.01) for hypoalgesia was present. A significant interaction was present between change in pain perception and group assignment in the low back (p = 0.01) with participants receiving a negative expectation instructional set demonstrating significant

algesia (p < 0.01).


The current study replicates prior findings of c- fiber mediated hypoalgesia in the lower extremity following SMT and this occurred regardless of expectation. A significant

in pain perception occurred following SMT in the low back of participants receiving negative expectation suggesting a potential influence of expectation on SMT induced hypoalgesia in the body area to which the expectation is directed.