Reconstructing physical activities in ancient humans has long been pursued in bioarchaeology to understand our history and development. Entheseal changes (EC)––variations to muscle, tendon, and ligament attachment sites on bone––have been used in bioarchaeology since the 1980s to reconstruct activities in past populations such as changes in mobility, subsistence strategy, and gendered division of labour. EC research is based on bone functional adaptation, where bone responds to mechanical stress on entheses through bone formation or destruction in varying degrees of expression. However, the relationship between EC and activity is more complex than simple cause-and-effect, as it involves multiple confounding variables, which can affect EC morphology. This article addresses the use of EC research in bioarchaeology through two parts: Part 1 defines entheses and EC, including observational and quantitative methods developed in bioarchaeology to study EC. Part 2 will summarize the main known factors that influence EC beyond activity such as age, sex, and body size. The article concludes with a discussion of varying benefits and limitations to EC research in bioarchaeology including the use of archaeological samples, historical collections, and animal experimental models. Overall, EC research can be difficult to link with activity due to its multifactorial etiology, challenges of efficacy in developing methods, and limitations of working with human remains. However, recent studies are showing more positive results, demonstrating the usefulness of EC as a way to reconstruct activity.
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