Chronic (achilles tendonitis, stress fracture, ‘tennis elbow’).

The idea

Chronic injuries develop gradually through repeated loading without adequate recovery, so symptoms build over weeks and worsen with continued activity. Achilles tendonitis is inflammation and degeneration of the Achilles tendon from repetitive running, jumping and calf loading, causing pain and stiffness above the heel. A stress fracture is a small crack in a bone from cumulative impact, common in the tibia, metatarsals and navicular of runners and dancers. Tennis elbow is overuse injury of the tendons attaching to the lateral elbow, caused by repeated wrist extension and gripping, not only by tennis. Classify by cumulative overload of tendon or bone and by the gradual onset, for example a runner with weeks of worsening shin pain suggesting a stress fracture.

What earns the marks

• Chronic injuries develop gradually from repeated loading with inadequate recovery rather than a single traumatic event.
• Achilles tendonitis is overuse inflammation and degeneration of the Achilles tendon from repetitive running, jumping and calf loading.
• A stress fracture is a small crack in a bone caused by cumulative impact, common in the tibia, metatarsals and navicular.
• Tennis elbow is overuse injury of the tendons attaching to the lateral elbow, caused by repeated wrist extension and gripping.
• Chronic injuries typically show gradual onset, pain that worsens with continued activity and relief with rest.
• Classification depends on the tissue overloaded (tendon or bone) and the cumulative mechanism, not on the sport alone.

Common mistakes and how to put them right

• Treating chronic injuries as sudden events.

  Put it right: Chronic injuries develop gradually through repeated loading, unlike acute injuries.

• Assuming tennis elbow only affects tennis players.

  Put it right: It is an overuse tendon injury of the lateral elbow caused by repeated wrist extension and gripping in many activities.

• Confusing Achilles tendonitis with an acute ankle sprain.

  Put it right: Tendonitis is gradual tendon overuse, whereas a sprain is sudden ligament damage.

• Believing a stress fracture is a complete bone break from one impact.

  Put it right: It is a small crack from cumulative loading over time.

Exam tips

• Identify the tissue overloaded, tendon or bone, and the repetitive mechanism to justify a chronic classification.
• Use the gradual onset and worsening-with-activity pattern in the question to distinguish chronic from acute injury.
• Name the specific site, such as the Achilles tendon or lateral elbow tendons, to show precise anatomical knowledge.