Bioarchaeologists have assumed, with limited evidence, that osteoarthritis (OA) and entheseal changes (EC) develop due to skeletal stress. To test this, the optimal study would compare OA and EC in individuals of known occupation, but few samples can support this type of study. I used a more widely applicable, underused method. I compared the rates and severity of OA and EC in four northwest Alabama prehistoric Native American populations and found that the two indicators did not co-occur consistently. Individuals with high OA or EC scores did not usually score high on both, suggesting that one or both factors are not reliable stress indicators.