Secrets of the Cuboid Notch

Remember Anatomy class in massage school? Yeah… me neither. But this piece of foot anatomy holds
the key to unlocking the lower body knee pain, chronic hip tightness and sciatica are present. How does
such a small (ironically) triangular notch tell us about what is happening in the lower body? Though the
power of Reflexology; that’s how.
In Reflexology, the cuboid notch is known to represent the hip/knee/leg reflex area. When I first learned
this I questioned “How can it represent all three?” I couldn’t figure it our until a few years back (pre-
Gasparilla) I worked with a bunch of runners all complaining of various leg issues and I was forced to
decode the cuboid notch. It turns out that the notch can be separated into three sections which relate
to very specific areas of tightness in the low body.
Looking at the picture in this article, we have three major sections of the cuboid notch: the incline,
decline and horizontal base of the triangle. These three areas represent the three major muscle groups
of the legs respectively: the quads, the hamstrings and the calf complex. Based on which of the three
areas you find the most tension indicates which muscle group is working hardest during the athletic
training process. Likewise if you notice one side of the notch to be comparatively weak that would show
a weakness where the body needs to increase training so stability can be present.
As an example, we can analyze a client coming in with knee issues. Well, where is the knee issue coming
from? Unless we palpate for which muscle group is the tightest and which muscle group may be
weakened due to injury or compensation we have no way of quickly figuring out WHY the knee pain is
manifesting. From a sports massage standpoint it can be a speedy alternative to master palpation of the
three surfaces of the cuboid notch, then to ask the client to perform a demo of their athletic activity to
confirm your analysis of potential hypertensive, weak and compensating areas.
There are two additional points on the notch that can be valuable to note as well. Between the
horizontal base (calf complex) and the incline (quads) we have the proximal head of the 5 th metatarsal
which represents the knee joint in Reflexology – illustrated by the red circle. At the apex of the triangle,
between the incline (quads) and decline (hamstrings), we have a representation of the sciatic nerve –
illustrated by the orange circle. These two points are very helpful to indicate true knee-joint congestion
and/or excess pressure in the sciatic nerve due to injury, over-training causing inflammation or general
stress which may be preventing proper execution of athletic activity.
Key Questions to Ask w/ Lower Body Dysfunction in Athletes
1) Where is it Coming From?
Just because the athlete points to their knee, lists all the previous injuries and surgeries they’ve had, all
the PT/OT they’ve done and they do everything except jump up and down to tell you it’s their knee….
Does not mean their knee pain is truly coming from their knee. Same thing with the back, shoulders,
feet, hands and really any other place in the body. Pain is a fickle beast and to paraphrase Ida Rolf:
Where you think it is, it ain’t.
2) What is the Regimen?
No matter how famous, how extensive their training background, how many degrees they have and
what kind of ‘safe’ training they do an athlete’s regimen can have holes in it. Is the body clearly telling
you that they are over-training and causing excess inflammation in the body? Are certain muscles weak

indicating a lack of proper training in certain muscle groups? Ask the body what it needs and you may
spot some easy fixes that can be missed by athletes with tunnel vision.
3) Recognizing Internal Factors
When there is no physical solution to recurring pain patterns there can be a heavy slant towards a
mental/emotional cause. Being vigilant of analyzing speaking patterns, body language and asking open-
ended questions can shine a light on whether or not to refer athletes towards more nervous system
oriented modalities like Reflexology, Craniosacral, Feldenkrais and/or mental health professionals.
Sometimes physical pain is a manifestation of internal pain that needs to be recognized before an
athlete is able to push through to the next level.
As you continue your work with athletes over the next year be vigilant of smart way to assess, apply and
regimen your time with them. I personally consider true athletes as special populations because their
needs and circumstances are so different from the ‘everyday client’. Being cognizant of an athlete’s
body, mind and spirit needs can be the turning point for you; from being a meat grinder to being a
Massage Therapist.

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