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The whole thing started with thoughts on how to help ‘adults’ (i.e. over 50) in some situations. The main issue was that we are becoming more and more immobile and inelastic – one more, the other less. Then we increasingly came into contact with younger people who were also chronically tense. One important moment is an orthodontic treatment, which can cause permanent stress for weeks and months. Another can be a – previously unrecognised – ‘special construction’ (I like to avoid the term ‘deformity’, it sounds so judgmental…).

After we had been approached a few times by families who already had someone with a nexus, it was obvious to try out what this could do for these actually flexible people – and miracle after miracle – it did, often enough anyway to systematically introduce this consideration. We have written a small leaflet for these cases (Nexus_Adult).

If you have seen Nexus in practice, you know the assemblage of different colours on our heating fins.

Of course, we tried to use beautiful colours for this cushion, but that’s the side issue. Essentially, the point is that the colours encode different degrees of hardness:

Anthracite is the hardest cushion, usually intended for – here relatively pain-insensitive – men. This is followed by the red and yellow pillows, which are clearly softer. The difference between the orange and pink pillows is rather small; these are even softer. In the case of women, we decide which colour is preferred, as the differences in hardness are reasonably small – and women think more aesthetically than most men…

Finally, the softest pillow is the grey one – the manufacturer could not offer a softer one, as the hardness is regulated by the amount of gas added, and too much here would lead to pores on the pillow surface. This model is still uncomfortable for many women – at least at the beginning. For the transition, you can put a terry towel in between to get used to it. In the long run, however, one should aim to lie directly on the pillow, as this ensures the best frictional connection between the nexus and the neck.

Now that a few Nexus are out in circulation (and many are used by several family members) comments, tips and suggestions are coming back. The ‘self-limiting’ use of the Nexus is interesting – we are very pleased about that. When one is well, the thing lies in the bedside table and is almost forgotten. Only when complaints come up again do you think about reaching into the drawer. Or sometimes not, in which case it first has to be ‘encouraged’ during a visit to our practice.

Perhaps it should also be emphasised once again that the following also applies here: A lot doesn’t help much! There is no point in sleeping on the pillow all night. Apart from a temporary numbness at the back of the head, nothing much happens, but it doesn’t help more than the 3-8 minutes we recommend.

So while it seems to make little sense to increase the duration of the treatment, it is possible to increase the strength of the stretching. The simplest thing to do is to put one arm on the forehead to increase the weight beyond the point of contact. Since there are no excessive forces involved, you can try this without risking anything. Several patients also told us that they had put small sandbags on their forehead, which ultimately has the same effect. Both can be tried out.

You can also modify the angle at which you lie on the cushion. For biomechanical reasons, it seems to make more sense to bring the chin forward and avoid overextension. People with a hunched back or a habitual head posture in a forward bend usually need a towel or a pad under the Nexus to bring the back of the head into contact with the contact surfaces of the Nexus.

Whether it is better to use Nexus in bed or on the carpet is judged differently. Especially those who use it in the morning usually do so in bed and get along well with it. Many of our patients with ‘stressful’ jobs also have copies in their offices and cantors and use Nexus during the day when they notice that too much tension has built up in their neck. They then usually just lie on the carpet. For the short time it takes, this is usually the easiest thing to do.

We have also heard time and again that the ‘helping eye’ of a partner can support lying straight on the cushion. Actually, the pillow – which is round – slides spontaneously into the right position, but sometimes the hint of a bystander can help.

A few years ago, it became painfully clear to me that above 50 (optimistically called ‘half-time’), some things no longer feel as good as they did as a youngster. Among other things, this included the sharpness of vision that slowly pushes you towards varifocals at this stage of life, but also the realisation that bones and ligaments are no longer as elastic as they were in youth.

Especially when there is external pressure – be it family, professional or financial storms – tension builds up in one’s own neck. The local muscles become firmer and more rigid, you become more immobile in the literal and figurative sense. Later on, radiating complaints appear: the shoulder can hurt, the elbow hurts and the fingers tingle. Others have breathing problems or think their heart is stumbling.

One deals with such things much more deeply when it affects oneself, but sometimes such initiatives also peter out – for lack of alternatives. An effective way to help would be to stretch the chronically shortened muscles and thus relax them. But you need someone to do it. Or one uses the good old glisson, a sling that is placed under the chin and back of the head and then put under traction. This was very popular in the fifties. The picture opposite illustrates how it works. Two details made the whole thing questionable:

*On the one hand, the apparatus rests on the shoulder muscles – exactly where there is already painful tension due to chronic shortening.

*On the other hand, it has an effect on the chewing and jaw apparatus, which we want to relieve as much as possible. This is because tension from this area is almost always involved when it comes to chronic neck tension.

Neither was ideal – to put it mildly. But in addition, the actual putting on of this frame is not very easy and can definitely give you the feeling of being locked in.

So I experimented with various devices to avoid these weak points: my attempts pulled on the zygomatic bone, fixed the forehead or supported on the mastoid; that’s the thick bony protrusion behind the ear. All at least as unflattering as Kuhlmann’s glisson.

In the back of my mind, however, I had the headrests that I had seen – e.g. in the Africa Museum in Tervuren, Belgium (here) in various versions. It was always stated there that these supports were to protect the hairstyle.

Now, one should not underestimate the vanity of one’s fellow men, but this seemed far-fetched to me. When you lie down on such a headrest, you quickly notice that it exerts quite a circumscribed pressure on your neck. The disadvantage of this piece, however, is that the pressure is applied to the neck at a right angle from the floor, so there is actually little traction.

Still, better than nothing and superior to the Glisson above in that you can lie on it quickly and comfortably. You are not cramped either.

I had seen in a documentary that users put a piece of cloth on it before resting their neck on the pillow. This seemed quite understandable to me after a self-experiment.

These headrests showed me a way. And I continued to tinker away. Until one day, fate brought the solution to my problem in the form of a young man with back pain. To make matters worse, I was able to help him relatively quickly after he had been suffering from low back pain for weeks and months. He wanted to show his appreciation for this and asked me how. Since we always note the patients’ occupations on the medical records – after all, the occupational burden plays an important role – it was immediately clear to me how this could be done.

I described my project to him. He was interested and so we sat together a few times in the pubs around Rathenauplatz to sketch out designs on the paper tablecloth in the classic way, which we then refined and concretised step by step. The next step was a polystyrene model, and finally a 3D simulation on the computer. Until then, everything was relatively cheap (apart from our wine consumption). But now came the crucial decision: continue or leave it at that.

Without any idea whether the whole thing would ever ‘work’, I decided to bite the bullet and finance a model and finally a mould. That’s a few thousand € you can get rid of. My product designer had brought me together with a competent specialist for plastic products who had already produced the model and mould (polyurethane specialist). This material is used in operating theatres, for example, where it has to be sterilised many times. It is completely indestructible and I suspect that our cushions will turn up again and again in later decades when households are liquidated (and will hopefully still find favour).

That’s how the first blank was made – and I was in a panic. The thing was much too hard! The difficulty in producing these polyurethane moulds is that you don’t get a smooth unstressable surface if you mix in too much propellant, i.e. you can’t make the moulds as soft as you like. We sat down together and Mr. Ajas and his team succeeded in making the foam so soft that the cushion is now comfortable to use and we are even able to offer different degrees of hardness. We then very hesitantly started to introduce the pillows to the people in the practice. Always with the ulterior motive of not letting this degenerate into a general shop.

Well, more than 5 years have passed and the NEXUS has been more successful than we ever dared to dream. We now have several different degrees of hardness to offer, the most important two being classic grey (very soft) and anthracite (harder) produced with inexpensive pigments. The intermediate grades differ only slightly. So whether you lie on a grey or an orange pillow is not sooo important – it’s more your preference for the colour that matters. The medium (red) hardness level has a certain justification, but here too you can lie on an orange (minimally softer) or yellow (minimally harder) pillow. We didn’t want to be unnecessarily expensive.

That was also the reason why we decided against selling the cushions through orthopaedic retailers alone. They simply have to calculate differently and the price of the cushions would have been far above 100€.

We also experimented for a long time with the dimensions of the support surface. Many users of the NEXUS are women and have assured us that they can manage just as well as ‘big-headed’ people like myself. Offering several formats would also exceed our limited possibilities.

In many cultures – e.g. African cultures – neck supports are regularly used. The common explanation is that they are used to support the head so as not to dishevel the hairstyles. This may be part of the explanation, but if you look at the devices used, you will notice that they are also applied directly to a very sensitive part of the neck.

So it is certainly not too far-fetched to bring into play the effect on the local musculature as at least a partial motivation for using these neck supports.
However, I have not yet been able to get direct information on this, and I would be grateful for any help…

Nexus is truly not the first procedure to therapeutically target the neck muscle insertion points.

As one example among many, I would like to refer to a book by Greenman who describes this as a soft tissue technique with condylar decompression. An osteopath friend of mine described to me with a smile how many of her patients fell asleep under this treatment, some with their faces blissfully relaxed. It’s not the silliest motivation to go in for phyiotherapy. Some hairdressers used to do it as a little extra when they cut or shaved their hair…

When using the Nexus, quite a few patients describe something similar – they simply fell asleep on it. This is not a problem, you can even spend the whole night on it if necessary, although we do not recommend it. Apart from a brief lack of sensation at the contact points, nothing much happens. The big advantage of the Nexus over physiotherapy/osteopathy is that you don’t need anyone to do it and you don’t have to travel anywhere. And then you can use it at any time. It is usually better to lie on it for 3×5 minutes throughout the day or when needed than for a quarter of an hour at a time.

And no one forbids you to combine the one (nexus) with the other (neck rub), especially if you succeed in convincing your partner to allow you to do so.