Entheseal Changes

El objetivo de este trabajo es estudiar las variaciones en la frecuencia de cambios entesiales a través del tiempo en Portugal para evaluar el efecto del aumento de la urbanización y la especialización laboral, aplicando un método de registro biológicamente apropiado, el llamado nuevo método Coimbra (Henderson et al. 2016a). La muestra analizada está compuesta por 138 individuos adultos provenientes de ocho sitios arqueológicos del actual territorio de Portugal, y con cronologías medievales y modernas. Se realizaron cálculos de prevalencias y de odds ratios, así como un test exacto de Fisher para los cambios registrados en once entesis de miembros superiores e inferiores. Los resultados sugieren que la actividad es un factor explicativo de los cambios entesiales registrados, pero que asimismo se deben considerar otros factores, ya que los diferentes perfiles de sexo y edad también contribuyen a las distintas tendencias. Además, el tamaño variable de las muestras de cada subgrupo también aporta a las altas frecuencias de algunos cambios. Sin embargo, este enfoque es fundamental para entender las tendencias temporales de los cambios entesiales.

Changes in subsistence strategy have caused some of the profoundest changes to the structure and health of humans. This study aims to test whether these changes have reduced work-load as assessed by entheseal changes. Entheseal changes, formerly called musculoskeletal stress markers, are thought to reflect muscle usage throughout life, although it is widely agreed that they have a multifactorial origin. This paper uses a meta-analysis of comparable published data to plot trends in time by muscle, enthesis type and sex. The results show that agriculturalists have the lowest scores for entheseal changes, with hunte–gatherers next highest and those working in industry the highest. These findings are the same for males and females, for most muscles and muscle groups. However, entheseal changes are highly correlated with increased age and the age distributions of the samples analysed could not be compared. It is, therefore, possible that differences in age distribution of the samples are one of the reasons for this finding. Recommendations are provided to reduce this and other limitations for future meta-analyses.

Identified skeletal collections, that is, skeletons for which sex, age at death and occupation at death are known, have been used to test methods for recording entheseal changes (EC). By testing methods on identified collections, the sensitivity of EC for recording activity levels can be ascertained prior to applying the methods to test hypotheses in archaeological contexts. However, the definition of occupational categories used for this research may, in itself, be a source of bias. The aim in this study was to test how categorising occupation affected the interpretation of EC. Male skeletons (n = 211) from two Portuguese identified skeletal collections were used. Three methods for categorising occupations, all of which have been previously published, were used each dividing occupations into five, three and two categories, respectively. Fibrocartilaginous entheses were recorded and EC scored as present/absent. Results showed that the method for categorising occupation affected the frequencies of EC found in occupational categories for specific entheses. Frequencies that were significantly different between occupational categories for one method were not necessarily significant for others. This demonstrates that the sensitivity of the occupational categorisation does affect the results. However, using logistic regression, we found age to have a greater effect than occupation. These results demonstrate the need for standardised occupational categories, as well as the importance of considering age. Copyright © 2012 John Wiley & Sons, Ltd.

It has been shown that age is an important factor in entheseal change (EC) presence, but this is for each independent feature. A random forest model has previously found a weak correlation between predicted and real age. The aim of this study was to use a multidimensional scaling model to determine the effect of occupation while controlling for age.

Entheses were recorded using the new Coimbra method in all males from the identified skeletal collection in Coimbra. Entheses chosen were the: supra- and infraspinatus insertion, subscapularis insertion, common extensor and flexor origins, biceps brachii and triceps brachii insertion. Occupations were categorised into heavy manual, manual, nonmanual and soldiers based on previous studies. The R package “randomForest” was used to partition the data into subsets of individuals in the same occupation category based on their overall EC expression, thus using all features. Several approaches were taken, but when clusters, based on these models were created, age was an important factor. Residuals from a regression model and later fitted values from the model were used to remove the effect of age. Age remained an important factor, but most importantly occupational categories did not cluster together well.

Despite previous studies showing that each feature of EC expression was not strongly affected by age, this study shows that age remains a more important than occupation as defined by these categories (but also when using the professions as documented in the collection). Other effects may be at play, particularly the difficulty of classifying occupations by biomechanical loading and non-occupational biomechanical loading, e.g. gardening or changes in occupation over life course.

The emergence of horse riding in Mongolia has recently gained attention in archaeological research (e.g. Houle 2016; Makarewicz et al 2018; Taylor and Tuvshinjargel 2018). Most of this research consists of zooarchaeological studies examining evidence of riding through osteological analyses of horse skeletal remains. This thesis represents an exploratory study on entheseal changes in human skeletal remains from the Bronze and Iron Age of Mongolia (c. 2500 BCE – c. 200 CE) to investigate patterns of repetitive physical activity that may be suggestive of horse riding. Entheseal changes refer to morphological alterations to bone caused by repetitive physical activity that are identifiable through bioarchaeological analysis (e.g. Hawkey and Merbs 1995; Villotte et al 2010). The study sample consists of 52 individuals from the National University of Mongolia and Züünkhangai, Mongolia. The “New Coimbra” method serves as the scoring procedure of entheseal changes in this study (Henderson et al 2016). Statistical analyses indicate patterns of entheseal changes that may be suggestive of repetitive and long-term horse riding are observed in individuals from the Late Bronze and Early Iron Age (LBA/EIA). These patterns are supported by recent ethnoarchaeological research on contemporary Mongolian riding techniques as well as zooarchaeological observations of osteological remodeling on prehistoric horse crania (Taylor and Tuvshinjargel 2018). Therefore, this study offers evidence for horse riding emerging in the LBA/EIA, which may have influenced the economic and sociopolitical transitions that occur during the Bronze and Iron Age.

Since the 1980s, entheseal changes (EC) have been widely studied as musculoskeletal stress markers in order to reconstruct habitual and occupational activities in past populations. However, physical activity is not the only determinant of the development of osseous changes at entheses. In recent years, a number of factors have been identified to play a role in entheseal expression, therefore, entheseal changes are multifactorial in nature. This dissertation investigates the prevalence and distribution of entheseal changes in a skeletal material associated with the battle of Towton (1461AD) in comparison to a control group from Box Lane, Pontefract (1090AD-1539AD). Using the revised Coimbra method, six entheseal markers of the upper limb were examined on both sides of the body: supra-and infraspinatus insertion, subscapularis insertion, common flexor and common extensor origin, biceps brachii insertion and triceps brachii insertion site. Entheseal changes were analysed in relation to age and robusticity of the humerus. Bilateral asymmetry and differences between the two archaeological populations were examined as well. The overall prevalence rate of entheseal changes for all muscle markers combined was 87.91% in the military population and 90.12% in the control group. Only a weak positive correlation was found between EC scores and age of the individuals: rs=0.212 (Towton) and rs=0.193; the results were not statistically significant. Nevertheless, when Spearman's correlation coefficient was calculated for each individual enthesis, moderate and statistically significant correlations were observed in the left supra-and infraspinatus (rs=0.472, p<0.05) and right subscapularis (rs=0.539, p<0.05) attachment sites in the males from Towton. In the control group, the left common flexor origin demonstrated a strong association (rs=0.900, p<0.01) between entheseal changes and age category. When employing aggregate EC composite scores, the overall correlation between the humeral robusticity serving as a proxy iv for body size and entheseal expression was weak (rs=0.219 and rs=0.174 in Towton and Box Lane samples, respectively). Based on the results of statistical analyses, individuals from the battlefield population did not exhibit more prominent entheseal changes than the control group, however, statistically significant differences were found in the humeral robusticity between the two archaeological populations (U=61.000, p=0.044). This indicates that musculoskeletal system of individuals from Towton was exposed to greater biomechanical stresses during their lives.

Entheseal changes take place at the interface between a muscle, tendon or ligament and a bone. By scoring the development of these changes this study measured the labour intensity of five skeletal collections from Ireland. The methodology employed was the Mariotti et al. (2007) entheseal scoring method, used to examine twenty-three postcranial enthesis sites on seventy-two male skeletons. Standard methods were utilised for skeletal sex determination and age estimation. One of the collections studied was excavated from a convict graveyard of the Victorian prison on Spike Island and facilitated an assessment of the biological effect of unfree labour patterns in comparison to free communities. The results found that while many prisoners had very high entheseal development, the entheseal evidence does not indicate a higher intensity of labour than the general population. A number of reasons for this were explored, including an unavoidable sample bias and a discussion of the complex concepts of free and unfree. The four other collections examined provided varied samples so that comparisons could be made between early medieval and post-medieval, urban and rural, Catholic and Anglican, young adults and older individuals. The two controlling factors of age and body size (estimated by humeral measurements) were examined; age was found to correlate with greater entheseal development but body size was found to have no
correlation, which may be due to the nature of a single-sex study. The results of this study have salient implications for the bioarchaeological study of the unfree, such as prisoners and slaves, as well as for the burgeoning field of enthesis studies.

During the examination of skeletal remains from historical periods, anthropologists often come across, among others, findings from soldiers’ graves as well. Aside from researches whose goal is to provide an interpretation of everyday life and habits of soldiers, their health status, examining the presence of ante-mortem and peri-mortem injuries which were not caused by accidents, but rather by deliberate violence (injuries caused by arms or tools, injuries as consequences of punishments or caused by fighting with “bare hands”, i.e. in direct frontal fights, etc.), and the level of medical care provided, the greatest challenge for the researchers is certainly the solving of problems regarding activity-induced stress markers linked to carrying military equipment, usage of specific types of arms or tools, riding, etc.,while the deceased were in active military service. While studying soldiers’ graves, our attention was especially drawn by graves of archers from several sites in Serbia: Timacum Minus, Singidunum, Romuliana, Banjska Monastery and Resava (Manasija) Monastery. Aside from examining their health status and pathological changes, special attention was dedicated to deformities, anomalies and entheseal changes that occur on the skeletons as a result of physical stress.

The main hypothesis of this study is that a Diplodocus was injured, resulting in a variety of paleopathologies described herein. Several bones
have unusual pathologies, such as a left pubis bone with an abnormal growth and a left femur with an extended fourth trochanter. Pathologies present
in these bones suggest an injury from an unknown cause, which the Diplodocus survived. The left pubis bone growth shows signs of possibly being
purulent, and the right pubis shows evidence of healing after fracturing due to the presence of a callus. Osteomyelitis may have occurred in a growth
from a pubis and enthesitis on the left femur, causing an extension to the fourth trochanter on the left femur from muscle strain. The extension of the
fourth trochanter on the left femur suggests that the m. caudofemoralis longus on the left femur was also damaged by the injury, and the healing
process involved fibrous entheseal changes to strengthen the muscle attachment site. It remains unknown if it was damaged in the same impact injury
or from a different, unrelated scenario.

In total 110 skeletons recovered from the Late Bronze Age (ca. 1100/900-760/500 cal. BC) cemetery Liushui, Autonomous Region Xinjiang, China (36 14 0 41.9 00 N, 81 43 0 23 00 E, ca. 2850 m a.s.l.) were suitable for observation of entheseal changes (EC presence which does not involve inferring soft tissue changes) and stress fractures. Four fibrocartilaginous entheses (lateral and medial epicondyles, the attachment sites of the quadriceps muscle at the patella and the patellar ligament, and the Achilles' tendon at the calcaneus) and one fibrous enthesis (plantar aponeurosis at the calcaneus) were scored in skeletons with respective anatomical structures preserved. Some variations in EC percentage values in relation to sex and age are documented, though the relatively small sample size limits robustness of statistical interpretation. Our results do not fully support age-related EC increase. Only medial epicondylosis and lower calcaneal spur show the most frequent occurrence in the 56e70 years age group, with substantially higher scores compared to the other age groups. Both tendinitis patellae and dorsal calcaneal spur have their highest scores in the 15e23 years age group. Dorsal spur, tendinitis patellae and lateral epi-condylosis are substantially higher among the female individuals than in the male skeletal remains from Liushui. Being compared with European prehistoric and industrial populations and with Californian historic hunteregatherers, the EC prevalence of the Liushui population indicates high physical activity levels with serious injury hazard. Grave goods and absolute chronology identify the Liushui population as mobile pastoralists at an early stage of the emergence of complex mounted pastoralism as a new economic and social system in Central Asia. The chronic nature of EC in the Liushui population, particularly noticeable in the female skeletons, may suggest an insufficient time for adaptation to permanent mechanical stress unavoidable in the prevalent mountainous environments. Relatively small sample size and the multifactorial etiology of EC require cautious evaluation of the obtained results. However, given the scarcity of palaeopathological records from the study region, our reconstructions and interpretations from the high-mountain Liushui site can be offered as a frame for further testing.

Entheseal changes (EC) are changes to areas where connective tissue (tendon or ligament) attaches to bone. Previous studies have suggested that heavy physical activity has an effect on EC development, among other factors such as age, body size, and (male) sex. In this study, EC in the upper limbs was examined in a Hellenistic-Roman rural population from Boğazköy, Turkey to assess gender differences in activity patterns. EC was positively correlated with age at death, and therefore, old adults were excluded when comparing the EC scores of males and females. Significant differences in EC between the sexes were tentatively considered as an indicator of gender-specific activities. Females exhibited significantly higher EC scores at the common extensor muscles' origin site (lateral epicondyle of the humerus), with a right-sided dominance. Common extensor muscles are related to movements of the wrist. It is assumed that the repetitive labor of weaving, spinning , and grinding may have caused these changes. Significantly higher EC scores in males than females were found only in the insertion site of the supraspinatus and infraspinatus muscles (greater tubercle of the humerus). EC scores in this shoulder-related enthesis also showed a right-sided dominance. It is assumed that some activities performed by males, such as woodcutting, shoveling, and building-related activities may have caused EC in this enthesis.

The present study aims to investigate the relationship between physical activity changes and the daily life patterns in the island of La Gomera (Canary Islands, Spain) during the aboriginal period (ca. 3rd–15th centuries AD). The commingled skeletal material used in this study comprised a minimum of 88 individuals from burial caves used by these agropastoral communities. The methodological corpus combines the study of entheseal changes in upper and lower limbs with a cross-sectional geometry analysis. The results revealed a prevalence of muscle chains linked to bilateral movements and a high mobility, probably more intense in the eastern areas of theisland. At the same time, we observed diachronic changes in mobility possibly due to processes of adaptation to an isolated environment. Finally, entheseal changes and cross-sectional geometry also indicated some differences between sexes as women seem to have had lower mobility than men.

Pregnancy is a critical period for animals where it undergoes many physiological changes including hormones, which are not received a great attention in rabbit. Therefore, a total number of 25 New Zealand White pregnant rabbit does were used, to assess the changes in concentration of relevant hormones in relation to rabbit productivity. Blood samples were collected on 14, 21 and 28 days of pregnancy and on kindling day to quantify six maternal hormones. Litter size and weight, in addition to average of weekly and total milk yield were determined. Concentrations of the six hormones during the second half of pregnancy ranged between 3.2 to 4.0 ng/ml for progesterone (P4), 47.3 to 89.0 pg/ml for estrogen (E2), 2.0 to 3.7 ng/ml for prolactin (PRL), 114.5 to 136.8 ng/ml for insulin like growth factor-I (IGF-I), 36.0 to 39.2 ng/ml for thyroxine (T4) and 1.9 to 2.2 ng/ml for triiodothyronine (T3). The corresponding values on kindling day were 1.6 ng/ml, 26.8 pg/ml, 4.6 ng/ml, 131.6 ng/ml, 37.4 ng/ml and 0.9 ng/ml, respectively. At day 14, maternal P4, E2, PRL, T4 and T3 were the lowest, whereas IGF-I was the highest compared to the other two days of pregnancy. At day 28, levels of E2, PRL, T4 and T3 were the highest in comparison with days 14 and 21 of pregnancy. On kindling day, P4 and T3 showed the minimal levels, whilst PRL exhibited the maximal level compared to the levels at all the gestational days. The relationship among the different hormones had various trends. The average of total milk yield (129.9 g/d) was negatively correlated with both P4 and E2, and positively associated with the PRL, IGF-I, T4 and T3 hormones. Furthermore, litter size was positively related with P4, E2 and PRL, and negatively with T4, T3 and IGF-I. Whereas, litter weight was negatively correlated with P4, E2 and T4. We recommend giving more attention to the rabbit doe reproduction, particularly close to parturition to achieve good economical return. However, further studies are urgently needed in this area.

Los marcadores óseos de actividad son huellas que dejan los esfuerzos físicos y posturas corporales que adoptamos a lo largo de la vida en nuestros huesos. En el caso concreto de los cambios de las entesis o alteraciones óseas a nivel de las inserciones musculares, su estudio se ha venido dando, tanto fuera como dentro de la península, a partir de los años 80.
En este trabajo se repasa la literatura existente sobre los análisis de los cambios entésicos. Para ello se ha realizado una búsqueda donde se han reunido 39 trabajos, independientemente si los cambios entésicos son o no el objetivo principal.
Siguiendo la tendencia del panorama internacional, no hay un consenso claro en lo que respecta a la metodología y, a gran escala, hay una ausencia de precisión en muchos de los términos empleados, en especial, en el ámbito anatómico. No obstante, los resultados que pueden llegar a ofrecer los cambios entésicos sobre la organización social y económica de los grupos del pasado son enriquecedores y, por ello, como perspectiva de futuro es importante procurar ajustar las metodologías a los conocimientos biológicos actuales, así como unificarlos para que la comparación de resultados sea más fácil.

Enthesopathies-that is, ''musculo-skeletal stress markers''-are frequently used to reconstruct past lifestyles and activity patterns. Relatively little attention has been paid in physical anthropology to methodological gaps implicit in this approach: almost all methods previously employed neglect current medical insights into enthesopathies and the distinction between healthy and pathological aspects has been arbitrary. This study presents a new visual method of studying fibrocartilaginous enthesopathies of the upper limb (modified from Villotte: Bull Mém Soc Anthropol Paris n.s. 18 (2006) 65-85), and application of this method to 367 males who died between the 18th and 20th centuries, from four European identified skeletal collections: the Christ Church Spitalfields Collection, the identified skeletal collection of the anthropological museum of the University of Coimbra, and the Sassari and Bologna collections of the mu-Grant sponsors: Maison des Sciences de l'Homme d'Aquitaine; Ministère de la culture, France (Projet Aires Culturelles) Synthesys Project. *Correspondence to: Sébastien Villotte, Laboratoire d'Anthropologie des Populations du Passé (LAPP, UMR 5199), in Wiley InterScience (www.interscience.wiley.com).

Located 10 km south of the Third Cataract
of the Nile River, the ancient city of Kerma was
once capital to the second largest state in Africa. The
Eastern Cemetery at Kerma (4 km east of city center)
encompasses 801 hectares and was used over a period
of 1,500 years (3,200–1,500 BC). Excavated in the early
20th century by George Reisner, the cemetery contained
an estimated 20,000–40,000 individuals. Reisner classified
these burials into multiple categories, including
chiefs and human sacrifices, based on burial position
and grave goods. This study investigates the skeletal
embodiment of social inequality by examining variation
in entheseal severity between the Kerma burial
classifications. Seventeen entheses were examined using
the Hawkey and Merbs (1995) scoring method (n5205
individuals); age, sex, and body size variables were considered
by employing Mann–Whitney U tests and partial
Spearman’s correlations. This analysis suggests that significant
differences in entheseal changes existed
between select burial types. Specifically, “corridor sacrifices”
had significantly higher rates of entheseal
changes while “chiefs” and “subsidiary burials” had similar
entheseal changes; furthermore, within these burial
categories, males had higher entheseal scores despite
body size controls. The elevated entheseal changes in
the sacrificial burials may be due to an intensive agropastoral
lifestyle or other demanding forms of manual
labor. In conclusion, the disparity of entheseal markers
between burial subgroups at Kerma might reflect a
degree of social inequality within this state level society.
This bioarchaeological research informs our understanding
of socially-defined categories of persons as well as
everyday life in Ancient Kerma.

Many anthropological studies have focused on enthesopathies to find the correlation between their occurrence on muscle insertion sites and physical activities. However, these works are rarely aimed at methodology of the scoring system. A new method is based on current anatomical and histological data. The aim of this work was to propose criteria for recording or not a stage with this method and test its reproducibility (interobserver error). We used a sample of twenty adult male skeletons from the medieval settlement agglomeration -Mikulčice. According to the Kappa coefficient, reproducibility of the method was substantial, and almost perfect for fibrocartilaginous insertions.

Studies on the relationship between intensity of activity and entheseal changes (EC) have usually focused on the upper limb. Body size may bias lower limb EC, and thus evaluation of activity intensity may not be applicable. We study the effects of age, body size (as femoral length and femoral head superoinferior height) and intensity of physical activity on the lower limb EC. Our study sample (Helsinki) represents early 20 th century Finns where age, sex and occupation are known for the individuals. Due to small number of females only males were included in this study. Based on the reported occupation, the material was divided into heavy (N = 17) and light (N = 6) activity groups. Entheses were observed for ruggedness, and the obtained scores were transformed into binary variables. Intensity of physical activity did not result in differences in EC in the lower limb. Surprisingly, also body size as femoral maximum length and femoral head height did not affect lower limb entheses. Age, a significant biasing factor in the upper limb EC, resulted in changes in some lower limb entheses. This was similar for left and right sides. Our results indicate that there are factors other than size, age and labour intensity affecting EC in the lower limb. Thus, the use of lower limb EC in activity reconstructions is problematic. However, our sample size was small which restricts the generalization of the results. Copyright

Entheseal changes (ECs) occur at the interface of the soft and hard tissues where the muscles transfer their energy to the skeleton and have, consequently, been used to infer activity patterns in past populations. However, the relationship between fibrocartilaginous entheses, development and activity pattern is still poorly understood. The aim of this research is to categorise the variety of changes and size of entheses in relation to puberty and activity-patterns in individuals. Hypothesis: ECs in the upper limb will be most prevalent in the post-pubescent manual workers and these entheses will be larger than the those who died during puberty.

Methods: New Coimbra method, measurements of entheses alongside a method to record puberty were used to record males aged 35 and under in the Coimbra identified skeletal collection (n=99). Results: All types of entheseal changes are seen in those who died during the growth spurt, dependent on enthesis and side. The size of rotator cuff entheses is larger in those performing heavy manual labour in both the growth spurt and post-pubescent groups, but is reversed for most other entheses. Overall most entheses are larger in the post-pubescent. Discussion: The results indicate the need to question the assumptions that activity-patterns and the ageing process are the causes of EC and further study the growth and development of these structures. Most importantly it highlights the need to consider each enthesis and type of change separately rather than ranking ECs by enthesis to study which muscles were most commonly used.

Lower levels of physical activity are often linked to higher socioeconomic status (SES) in past societies. As an activity marker, changes at muscle attachment sites known as entheseal changes (ECs) have been used with varying efficacy. This study investigates this proposed link between EC as a physical activity marker and SES within one well-defined temporo-geographic context. EC data from 16 entheses in three skeletal collections from the postmedieval town of Aalst, Belgium, were evaluated using the Coimbra method. The skeletal assemblages represent distinct socioeconomic groups, evidenced by historical and dietary isotope data. The Louis D'Haeseleerstraat sample represents lower class individuals (n = 46), the Hopmarkt sample middle-class individuals (n = 110), and the Saint Martin's church (n = 13) higher class individuals. EC data are tested for correlation to status, age, and sex. EC patterns did not differ significantly between the SES groups at any entheses except the musculus (M.) iliopsoas and common extensor, where the higher class showed more EC. Within the populations , at the Hopmarkt, sexual differences were only observed in the Achilles tendon attachment, whereas at the Louis D'Haeseleerstraat, sexual differences were present in the M. triceps brachii, M. brachioradialis, and quadriceps entheses. Only some entheses showed a significant correlation with age, and these were inconsistent between populations. ECs are not a reliable indicator of SES in postmedieval Aalst. This could suggest that the hypothesis that the wealthy were less physically active oversimplifies the lives of people in the past. It could also suggest that EC is not a suitable proxy for physical activity, or that it cannot be used without in-depth knowledge of the types of activities performed by various socioeconomic groups in addition to consideration of all other aetiological factors. This study illustrates the caution necessary when using EC as a proxy for social status in past societies.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

The effects of Egyptian imperial expansion into Nubia during the New Kingdom Period (1,550-1,069 BC) have been debated. Here, the impacts of the Egyptian Empire are investigated through an examination of osteological indicators of activity at the archaeological site of Tombos. Entheseal changes to fibrocartilaginous attachment sites and osteoarthritis are examined to infer what types of physical activities this colonial town was engaging in. Many of the skeletal remains at Tombos were comingled due to looting in antiquity; undisturbed burials are presented as a subsample of the population (n 5 28) in which age, sex, and body size can be considered. The total sample in Wiley Online Library (wileyonlinelibrary.com).