The Coimbra Method: An Entheseal Scoring Workshop at the University of Sheffield, 28th January 2015

18 Jan

The University of Sheffield is playing host to a day-long workshop on the Coimbra method of scoring enthesophytes on the Wednesday 28th of January 2014.  It is a first come first served basis as attendance (at £10 and £5 concessions) is limited, though there are still some places available – you can find out more information and book here.  Dr Charlotte Henderson from the University of Coimbra, is one of the developers of the Coimbra method of recording enthesophytes in human skeletal remains and will be helping to lead the workshop.  The workshop welcomes anyone who works with the skeletal remains of past populations, although it would be particularly suitable for researchers and students involved in biological anthropology or osteoarchaeology.

Enthesophytes, also known as musculoskeletal markers (often abbreviated to MSM), are observable indicators of activity-induced stress on bone, often appearing as bony projections.  They are present on the origin and insertion of muscle on bone in the form of the ossification of the tendon and ligament attachments that help anchor the body of a muscle to the bone itself.  They are often the product of repetitive movements or of a demanding physical lifestyle and, when scored and recorded at a population level with the correct controls in place, can be used to infer as Markers of Occupational Stress (MOS).  This is partly why it is important to become familiar with musculoskeletal anatomy as a human osteologist because the two systems are so entwined in their action.

It should be mentioned here that enthesopathies are distinct from osteophyte formation on, or around, the joints (and not at muscle origins or insertions) which also look like bony projections.  There can also be a presumption in the palaeopathological literature to use the evidence of osteoarthritis alone in skeletal remains as an indicator of a physically demanding lifestyle; this should only be considered when used in conjunction with the observation and the recording of differences in the size of the left and right-side bones, size and location of any enthesophytes present, other pathological lesions, and certain non-metric traits in the individual (Roberts & Connell 2004: 38).

Although well-studied within the osteoarchaeological literature, there are still gaps in the knowledge of the cause of enthesopathies.  Further to this is the fact that rarely are musculoskeletal markers recorded in detail during the initial osteological analysis of archaeological remains. There is also, for instance, ongoing debate regarding the action of disease processes in the forming, or influencing, of both fibrous entheses and fibrocartilaginous entheses, as well as the difference in left and right side prevalence, and the effect of life course changes on enthesophytes (Hawkey 1998, Villotte & Knüsel 2013).  However, there has been a deepening of the understanding of the cause, development and implication of enthesophytes in the human body in the recent osteoarchaeological literature (Villotte et al. 2010).  Particularly regarding the likely multi-factorial influence in the aetiology, or cause, of these physical alterations (Villotte & Knüsel 2013).  New technology, such as 3D photogrammetry, is also helping to produce large databases of comparative material, as well as clearer macro and micro visual images of the anatomical changes present in enthesophytes.

The data scored and documented on individuals can, when analysed at the population level, lead to observations on the physical repetitive movements needed to produce the musculoskeletal markers.  The Coimbra method has started to become a standard within the recording of enthesophytes, although I personally will have to wait until the workshop to learn about this in detail.  Interpretations can thus be made, and hypotheses tested, on the ability in identifying past-activity patterns of archaeological populations.  They can also be used to hypothesize the actual range of active movement during the life of an individual.  Hawkey (1998), for instance, has demonstrated the ability to reproduce possible movement patterns available to a severely disabled individual in a Pre-Colombian context in New Mexico.  Hawkey & Merbs (2005) later used MSM’s to highlight subsistence change within the Hudson Bay Eskimos, noting that different activities could be differentiated via the skeletal anatomy and related changes to stress.

Although this entry is possible a tad late, I will be attending the 1 day long course and will endeavor to produce a blog entry detailing what I learnt during the workshop itself.  As always with this blog, if you or your department are hosting a workshop or a short course in human osteology, biological anthropology or osteoarchaeology, and want to let others know about it, then please feel free to contact me and I’ll help spread the word.

Further Information

  • Details of the 1 day long Coimbra method workshop at the University of Sheffield can be found here.  The university has a well-developed osteology laboratory and Masters program at the Department of Archaeology – you can learn more about the osteoarchaeological research carried out at the University of Sheffield here.
  • The University of Coimbra’s Department of Anthropology hosted an international workshop back in July 2009, titled Musculoskeletal Stress Markers (MSM): Limitations and Achievements in the Reconstruction of Past Activity Patterns, that has proved instrumental in rejuvenating the scientific study of MSM’s.  A full workshop abstract booklet can be found here and Prof. Charlotte Robert’s thought-provoking perspective on 25 years worth of study on MSM’s can be found here.
  • If you have either academic access or subscribe to the International Journal of Osteoarchaeology journal, it helpfully released a special edition in 2013 (Vol 23 (3): 127-251) titled Entheseal Changes and Occupation: Technical and Theoretical Advances and their Applications, which details and summaries the importance of the many recent approaches to MSM’s and OSM’s.  Read it here.


Hawkey, D. E. 1998. Disability, Compassion and the Skeletal Record: using Musculoskeletal Stress Markers (MSM) to Construct an Osteobiography from Early New Mexico. International Journal of Osteoarchaeology. 8 (5): 326-340.

Hawkey, D. E. & Merbs, C. F. 2005. Activity-induced Musculoskeletal Stress markers (MSM) and Subsistence Strategy Changes among Ancient Hudson Bay EskimosInternational Journal of Osteoarchaeology. 5 (4): 324-338.

Roberts, C. & Connell, B. 2004. Guidance on Recording Palaeopathology. In: Brickley, M & McKinley, J. I. (eds.). Guidelines to the Standards for Recording Human Remains. IFA Paper No. 7.  IFA & BABAO. pp 34-39. (Open Access).

Villotte, S., Castex, D., Couallier, V., Dutour, O., Knüsel, C. J. & Henry-Gambier, D. 2010. Enthesopathies as Occupational Stress Markers: Evidence from the Upper Limb. American Journal of Physical Anthropology. 142 (2): 224-234.

Villote, S. & Knüsel, C. J. 2013. Understanding Entheseal Changes: Definition and Life Course Changes. International Journal of Osteoarchaeology. 23 (2): 135-146.


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