Advancement and acceleration in medico-legal practice: what’s it all about?

In 2013 we ran a session entitled, ‘Pain, Percentages, Advancement/Acceleration and other nebulous concepts in medico-legal practice’ at the BOA Annual Congress in Birmingham. The session was vastly oversubscribed with people sitting/standing in the aisles and over 50 attendees locked out by the fire safety officer. Speakers included a barrister, psychiatrist, pain specialist and an orthopaedic surgeon. The level of interest in this session emphasised the topicality of the issues under review. As I continue to read medical reports in personal injury claims where it is argued that such and such an injury has caused the onset of certain symptoms and disability to be advanced/accelerated by a certain period, I thought that it might be worth re-visiting the subject to consider its validity in these cases. What do we mean by advancement or acceleration of symptoms? Effectively we are arguing that given the nature of the underlying condition (most commonly back pain), and our understanding of the epidemiology and pathophysiology of that condition, the injury or incident in question has brought forward what would invariably have happened in any event by a certain period of time. Clearly if a pedestrian is walking along the pavement and is struck by a car, it would be ridiculous to argue that this insult had brought forward the tibial fracture by a certain period. However, in a condition as common as back pain where most of the patients we see in clinical practice develop symptoms during the activities of daily living, rather than after a specific injury, it is frequently argued that such an injury or incident has triggered the onset of symptoms which would probably have come on at a later date in any event. Why do we introduce the concept? The simple answer is that we are trying to help the legal …