Pious Pain: Repetitive Motion Disorders from Excessive Genuflection at a Byzantine Jerusalem Monastery

Abstract

The monastic site of St. Stephen’s in Byzantine Jerusalem (fifth to seventh centuries AD) provides an excellent example of the strength of a biocultural approach, synthesizing evidence from skeletal, archaeological, and written records in a holistic reconstruction of daily life. The bones of the monks themselves provide biomechanical evidence of excessive kneeling resulting in severe degeneration of the knees and feet, including extensive arthritis, pronounced musculoskeletal markers, and the formation of nonmetric traits associated with repetitive motion. Historical and liturgical texts from the region and period indicate that hundreds of genuflections per day may explain these pathological responses. Such behavior would have led to chronic pain, from which the monks could not have escaped whether standing, sitting, or lying down. And yet, long after the onset of such pain, the degree of degeneration confirms they continued the very practices that led to worsening conditions. This allowed us to use the biological record to explore social phenomenon such as deference to authority, the genesis of prayer posture, and the symbolic meaning of suffering. Pious adherence to a regimented daily monastic schedule defined by prayer led to degeneration of the joints of the lower body that resulted in severe, chronic pain. Individuals were well aware that their knees and feet hurt during genuflection, increasingly so with time; however, they continued the activity well beyond marked indications of pathology.