International Journal of Osteoarchaeology

Int. J. Osteoarchaeol. 8: 305 310 (1998)

Markers of Occupational Stress:

Conspectus and Prognosis of Research
KENNETH A.R. KENNEDY*
Ecology and Systematics, Division of Biological Sciences, Cornell University, Ithaca,
NY 14853, USA

ABSTRACT

In his role as discussant of the papers presented at the symposium on Activity Patterns and
Musculoskeletal Stress Markers: An Integrative Approach to Bioarchaeological Questions at the
66th Annual Meetings of the American Association of Physical Anthropologists held in St. Louis,
Missouri, on 4 April 1997, the author summarizes topics presented by the participants and
others, discusses innovative methodological procedures and statistical approaches advanced by
these contributors, and offers concluding remarks about the present status of studies of markers
of occupational stress (MOS), which include investigations of specific markers of musculoskeletal
stress (MSM) and degrees of skeletal robusticity (RM). The recent resurgence of interest in
identification and diagnosis of habitual patterns of activity, as registered on bone and dental
tissues, is exemplified in this collection of reports by scholars active in the fields of forensic
anthropology, palaeodemography, palaeopathology and human skeletal biology. Earlier hypotheses are reassessed by new methodologies, but formulation of reliable standards for
recognizing MOS and interpreting their underlying causes remains a challenge for the advancement of future research programmes. 1998 John Wiley & Sons, Ltd.

Key words: occupational stress; musculoskeletal stress; skeletal robusticity; markers

Introduction
The scientific study of osseous and dental modifications produced by habitual patterns of activity which are observable in living skeletal
human subjects has found its place as an accepted component in the protocol of palaeodemographic
research
and
forensic
anthropological investigations. Commonly referred to as markers of occupational stress
(MOS), these indicators of activity-induced
changes include musculoskeletal stress markers
(MSM) and robusticity markers (RM) in cases
where muscles or tendons insert into the cortical tissue of bone via the periosteum, or where
there is hypertrophy of muscular attachments
on the bones. Physiological and cytological processes involved in osteon remodelling and the
biomechanical effects of stress on bone are well
documented in the anatomical literature [13].
Diagnosis of activity-induced stress began in the
* Correspondence to: Ecology and Systematics, Division of Biological Sciences, Cornell University, Ithaca, NY 14853, USA.

CCC 1047482X/98/050305 06$17.50

1998 John Wiley & Sons, Ltd.

Middle Ages [4] with a medical literature

emerging with the onset of the Industrial Revolution [5]. Anthropologists and anatomists became interested in MOS at the time of the first
discovery of hominid fossils in Europe in the
mid-19th century, and a survey conducted in
1989 documented over 145 cases of MOS reported in the annals of industrial medicine,
sports medicine, performing arts and anthropology [6].
The papers presented in the symposium Activity Patterns and Musculoskeletal Stress Markers: An
Integrative Approach to Bioarchaeological Questions
testify to the advances achieved in the study of
MOS since the 1960s when the late J. Lawrence
Angel [7] revived this area of scientific endeavour and recommended procedures for achieving
more accurate observations and diagnosis.
Present-day anthropologists are more critical of
their data than were their predecessors, and
simplistic explanations for the causes of specific
MOS have given way to more careful scrutiny
and reassessment of both etiologies and maniReceived 29 June 1998
Accepted 3 July 1998

306
festations of bone remodelling changes [8]. The
most exciting aspect of modern trends is the
application of the MOS data to test hypotheses
in the archaeological record of historic and
prehistoric populations and, in some cases, confirm earlier interpretations of MOS from written
accounts [9].

Symposium papers
The effects of age, sex and handedness registered in quantitative measurements of muscular
insertions are addressed by Cynthia Wilczak
who examined skeletal series of prehistoric
agrarian populations from New Mexico
(Hawikah) and Kentucky (Hardin Village), a
hunting-foraging population from Kentucky (Indian Knoll), whaling communities in Alaska
(Mummy Cave and the Kuskokwim River site)
and modern populations of Afro-American and
Euro-American ancestry from the Terry and
Todd collections. Except for osteoarthritis, studies of age effects on bone have been relatively
neglected, as have observations of skeletal
asymmetry, differences in body size and hormonal factors in ontogenetic development.
These variables are addressed by Wilczak in her
development of a methodology to assess muscular robusticity in males and females of different
ages. She has isolated certain features of skeletal
development which can be separated from other
factors exerting habitual stress on the body. A
two-way MANOVA procedure was performed
separately for specimens of both sexes to discern the effects of age and ethnicity on the sizes
of eight insertion sites. This procedure was
followed by ANOVA analysis to test the effects
of age on specific insertion sites without interference from ethnic variables. Wilczak concludes that the asymmetry encountered in this
study of differential use of muscle groups need
not result in hypertrophic expressions on the
same side of the upper extremity for all insertions, and that the sizes of insertion sites may
not be expressed in a manner that consistently
reflects handedness. In short, random variation
must not be excluded from consideration in the
examination of side-specific stress hypertrophy.
Pathological and nutritional variables may result
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K.A.R. Kennedy
in insertion asymmetry. Further analysis of these
variables will prove rewarding to the biological
anthropologist as new methodologies are developed within the compass of MOS analysis.
Also set in the southwestern sector of North
America is Diane Hawkeys study of musculoskeletal markers in prehistoric skeletal material
from Gran Quivira, New Mexico, but with a
focus upon an osteobiographical interpretation.
This involves an individual who suffered from a
severe skeletal disability. The pathological condition is diagnosed as a systemic form of juvenile chronic arthritis, as supported by
histological and morphometric data. Assuming
the onset of this condition in late adolescence
and survival of its victim until earlymiddle
adulthood, it is obvious that his survival depended upon care by at least one member of his
community over an extended period of time.
Hawkey dismisses the arguments put forth by
Dettwyler [10] and others that survival of a
physically impaired individual does not imply
receipt of compassionate care. Neglect of the
sick is not a characteristic behavior pattern of
our species, and evidence for care of the disabled is suggested elsewhere in the palaeontological and archaeological record, as among the
Neanderthals of Shanidar in Iraq [11]. This
Gran Quivira individual suffered entire loss of
lower back mobility due to ankylosis, ossification of the flavian ligaments, ventral collapse of
the vertebral bodes, degenerative joint disease
and severe osteoporosity of the vertebrae.
Hawkeys study should lead to other investigations into the place of disabled individuals in
ancient and contemporary societies with respect
to age at time of death and recognition of the
development of pathology, trauma and habitual
stress.
What is the utility of analyzing variations in
skeletal marking and robusticity as a measure of
labour intensity? This question is posed by
Steven Churchill and Alan Morris who examine
muscle scar rugosity in three samples of Khoisan
skeletons derived from distinctive ecological
settings in the southern Cape Province of South
Africa within a time frame of 91002000 years
ago. Robusticity was measured for eight upper
extremity muscles and six lower extremity muscles in a sample of 75 skeletons; between-group
Int. J. Osteoarchaeol. 8: 305310 (1998)

Markers of Occupational Stress

differences were examined by sex. The authors
conclude that biotic differences had a greater
effect upon males, especially with respect to
greater robusticity of the upper extremities. A
heavy reliance upon marine resources may have
ameliorated differences on terrestrial resource
distribution among one of the Khoisan groups.
Furthermore, a near-significant correlation of
femoral collo-diaphyseal angles is present between males who were savannah foragers and
males whose foraging activities took place
within forest environments. They suggest that
peak efforts of activity may do more to increase
robusticity than habitual contractions. Lifting an
animal carcass may significantly promote enthesic rugosity to a greater degree than lowerstress habitual contractions of the lower
extremities, as in walking. Between the sexes of
their sample, Churchill and Morris suggest that
biotic differences between regions had a greater
effect upon male than female subsistence labour,
assuming a sexual division of labour in these
groups comparable to that observed in ethnographic studies of the San people. This study
finds support in Wilczaks examination of the
effects of age, sex and handedness on quantitative measurements of muscle insertion.
Another prehistoric population is investigated
by Jane Peterson, the terminal Pleistocene Natufians of Palestine and Jordan whose hunting-foraging practices may have been combined with
incipient agriculture some 1250010000 years
ago. She also looks for signs of musculoskeletal
stress scars on bones of the upper extremities,
but with specific attention to weapon technology and use. Muscle and ligament attachments
are examined at 24 loci for both sexes of specimens excavated from five Natufian sites. Asymmetry in musculoskeletal stress scars and
degenerative joint diseases suggest that males
were engaged in habitual activities that were
more lateralized than in females, especially for
triceps brachii and anconeus. Peterson associates
asymmetry with hunting activities by males,
particularly with respect to spear throwing and
atlatl use. Several weapon systems may have
been used simultaneously including, perhaps,
the bow and arrow. Evidence for this latter type
of armature has been based upon the archaeological record of microlithic points of which
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307
some might be arrowheads. But Peterson is
cautious in proposing that humeral asymmetry
may be the consequence of unilateral flexion of
the right elbow and extension of a compressive
force of the left arm when a more convincing
case can be made for throwing activities as the
agent behind male upper extremity lateralization, an interpretation supported by other investigators familiar with terminal Pleistocene
skeletal series [12,13].
In their evaluation of musculoskeletal stress
markers and habitual activities in skeletons from
two Alaskan Eskimo populations of the Norton
Sound region, Susan Steen and Robert Lane
conclude that males and females engaged in
different practices in harvesting seasonally available plant and animal food resources. Differences occur within the populations from
Golovin Bay and Nunivak Island skeletal series
as well as between these two groups. Sample
sizes are 47 males and 57 females from the first
area, and 64 males and 70 females from the
second area. The Golovin Bay skeletons date
from 300 to 80 years ago; the Nunivak Island
skeletons are from nine prehistoric sites.
Golovin Bay females exhibit greater usage of
pterygoid medialis and masseter muscles in chewing
activities than do Nunivak Island females. Other
differences in musculoskeletal markers are observed in the lower extremities, and the authors
discuss possible causes for these bone modifications. This study highlights the importance of
standardization of recording and scoring procedures in analyses of activity-related markers as
well as demonstrating that there may be morphological differences between populations inhabiting
similar
ecological
settings.
Furthermore, within these arctic hunting-foraging communities there may be striking differences in stress markers between males and
females.
Ann Stirlands study emphasizes the importance of determining how muscles function in
groups (rather than singly), as represented in
her observations of humeral muscular insertions
in skeletons of professional archers from Henry
VIIIs flagship, the Mary Rose, which sank off
Portsmouth in 1545, and from the medieval
cemetery of St. Margaret in Norwich. In comparing her samples of 100 pairs of humeri of
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308
young and mature adults males from these archaeological contexts with radiographs of 49
young divers in the Royal Navy, Stirland
ranked scores for entheses at the insertion areas of pectoralis major, latissimus dorsi, teres major
and deltoid. Significant differences were observed in cortical areas and percentages of cortex presence between different ages of
individuals and between right and left humeri.
Attempts to evaluate areas of insertion by metrical and morphological observations were considered to be of limited scientific value. This
problem is attributed to the fact that only
groups of muscles should be considered in
evaluating activity patterns from skeletal specimens. Stirland notes that the modern British
divers enjoy a higher standard of health and
nutrition than individuals represented in her
archaeological series. However, the archers of
the Mary Rose were professionals on board
who had carried out their skills over relatively
long periods of time. Stirland questions the
assumptions of some of her colleagues that
terms such as Skeletal Markers of Occupational Stress, Markers of Occupational Stress
and Musculoskeletal Stress Markers properly
define structures on bones which are formed
by entheses or syndesmoses as a result of habitual activity patterns.
These reservations about associating muscle
markings with a certain activity are shared by
John Robb. Not only are muscle insertion sites
morphologically complex and difficult to identify, but the skeleton registers a mosaic of activities over the course of each individuals
lifetime. Furthermore, interpretations of activity
patterns of ancient peoples may be influenced
by current gender and social biases unsupported by historical or ethnographic documentation, and by the limitations of observations
based upon analyses of single individuals. By
focusing upon general patterns of behavioural
variability within a population or sample,
rather than identifying specific activities
through muscular insertion loci, Robb analyzed
data from 18 muscle sites in 56 adult males
from the Iron Age necropolis of Pontecagnaro,
Italy. His reference collection was a series of
61 adult skeletons from a 19th century cemetery in Syracuse, Sicily. Skeletal developments
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K.A.R. Kennedy
are related to an individuals sex, age and activities performed, and are revealed by results of
statistical measures which may reflect lifeways
and organization of work within the social
structure of a community. Employment of
bivariate and multivariate methods demonstrate
how surface markings on bone are susceptible
to this approach. Comparisons made between
age-balanced populations are recommended because muscle markings are expressions of ongoing skeletal changes from young adulthood to
advanced age.

Summary and Conclusions

These symposium papers are impressive because of the variety of topics and diversity of
approaches undertaken by their authors in the
study of markers of occupational stress. They
mark the resurgence of interest in this topic
during the past few years, but more importantly they offer reorientations of methodology
in defining MOS and their anatomical expressions as musculoskeletal stress markers and robusticity markers. What have we learned from
these present studies which is less apparent in
the pioneering works of earlier investigators?
No longer can we attribute a specific modification of bone or dental tissue to a single
pattern of activity however useful this practice
might be in establishing individuation in the
context of a medical-legal investigation. Rather,
it is the overall pattern of stress which best
describes the habitual activities in which an
individual may have engaged in life. In some
cases our diagnosis must be restricted to stating
that an individual had engaged in some form
of strenuous labour; at best we may be able to
isolate markers of habitual stress to certain
anatomical regions, such as the bones of the
upper extremities, lower extremities, thorax,
manual and pedal appendages, etc. From these
observations it is possible to suggest a range of
cultural practices which may have wrought
these skeletal modifications with reference to
archaeological or historical records. In short,
MOS must be interpreted in relation to the
entire individual, viz. the skeleton, and not as
isolated phenomena.
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Markers of Occupational Stress

We perceive in these symposium papers that
there is a thin line between the diagnoses of
diseases and the activities in which their sufferers habitually engaged. This is demonstrated by
descriptions of osteoarthritic changes and heavy
labour, such as load-bearing. However, it is
questionable that excessive joint activity leads
to joint deterioration in every case. If degenerative joint disease is an inevitable consequence of
aging, then its degree of expression must be
weighed against behavioural activities that
would exacerbate this relentless process. It is
with problems of this sort that the present
studies of lateralization are helpful, particularly
when examined in the contexts of age and sex
of individuals in the study sample.
While the present studies point the way to
the future, a significant obstacle stands in our
path and needs to be addressed. This is the
absence of standards for making accurate identifications of MOS and determining their etiologies. Too much of the earlier literature on the
subject is anecdotal and earlier untested interpretations persist in the scientific literature.
With the compilation of a catalogue of MOS by
this author in 1989 [6] it was deemed useful to
list those modifications of bones and teeth
which previous investigators had assigned to
specific activity patterns. It was not within the
scope of that study to assess the reliability of
the diagnosis of each marker of occupational
stress. Now we are at the threshold of achieving
a rigorous assessment of anatomical variables
attributed to habitual activity patterns by application of new observational and statistical analyses, such as those discussed in this set of
symposium papers, and thereby establishing
standards which will evolve from sound physiological and anatomical data. Rather than continuing the venerable practice of first deciding that
a bone modification is a marker of occupational
stress, it is recommended that we initiate investigations with a sharper perception of how bone
remodelling takes place and which kinds of
modifications bone may assume within the configurations of habitual activity revealed in archaeological and historical sources. To do so
will deliver us from the blunder of Currus bovem
trahit praepostere.1
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309

Acknowledgements
The author thanks Drs Jane Peterson and Diane
Hawkey, organizers of the symposium Activity
Patterns and Musculoskeletal Stress Markers: An
Integrative Approach to Bioarchaeological Questions,
for inviting me to serve as their Discussant
following the presentation of papers at the
Annual Meeting of the American Association
of Physical Anthropologists held in St. Louis,
Missouri, in April 1997. My colleague Dr
Cynthia Wilczak is thanked for her valuable
comments on the materials summarized in this
final paper of the symposium series. Rosie
Brainard provided invaluable assistance in various clerical tasks in the preparation of this
manuscript.

Notes
1. To put the cart before the ox.

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