Linking MSM (Musculoskeletal Stress Markers) to specific activities is difficult. This problem is explored by combining and comparing patterns of MSM and material culture. Sex- and age-related patterns for MSM and grave goods distributions are analysed and compared from five Pitted Ware (c. 3400–2300 BC) sites on Gotland, Sweden. Possible links between MSM patterns, burial objects, faunal remains and subsistence are explored for a better understanding of some of the irregularities surrounding the Pitted Ware culture hunter-gatherer complex on Gotland. Fifty-two muscle and ligament attachments on seven skeletal elements were scored on adult skeletal remains (n = 126) from the five Middle Neolithic Pitted Ware sites at Ajvide, Västerbjers, Visby, Ire and Fridtorp. Noteworthy differences were observed in MSM mean scores between the sexes as well as significantly increased scores with increased age. Distributions for ten selected grave goods categories were also examined for the adult individuals as well as for 50 subadult individuals. The grave goods frequencies showed the opposite pattern from that of MSM: young individuals had higher frequencies of the selected grave goods than the old, and females generally more than males. Burial find distributions also differ at the five sites, as well as faunal refuse proportions, while isotopic data indicate homogeneous subsistence all over the island. Circumstances surrounding the faunal remains in graves and surrounding cultural layers indicate site-specific utilisation, but also ritual handling of animals. An image of common identity on the island and membership of the local community is visible in the material culture. In addition, individual differences are apparent through MSM patterns and grave goods, but not in direct correlation to activities implied by the artefacts in the grave. Copyright © 2008 John Wiley & Sons, Ltd.