The night wrap is an overnight local anti-inflammatory treatment for inflamed soft tissues. I find it very effective for the management of tendon pain, most notably around the achillies. It doesn't have a large body of evidence, but anecdotally, night wraps seem to help particularly in those cases of severe stiffness and pain when first waking in the morning,
What you'll need:
- Diclofenac gel (E.g. Voltaren gel)
- Hirudoid cream
- Glad wrap
- Gauze
1. Just before going to bed, massage a small amount of equal parts Hirudoid and Diclofenac into the painful area for 2-3mins until it has been absorbed into the skin.
2. Apply an additional larger quantity of the cream and gel and lightly massage till they have mixed together. Leave this as a thick layer on top of the skin.
3. Wrap up the injured area in glad wrap and you're done!
4. Go to bed and let the night wrap do its thing. Note: If the injured area is around a boney prominence, like the achilles insertion into the heel, then apply a thin piece of gauze on top of the layer of cream/gel to help keep it in place and not slide off the injured area when wrapping it up in glad wrap or when in bed.
How does it work?
Its proposed mechanism is by providing a sustained and high dose (compared to just massaging it in) topical anti-inflammatory effect. Depending on how much sleep you get, the cream can get a decent 8 hours or so of time to do its thing while you're in bed, so it's working while you sleep. The addition of Hirudoid cream is especially helpful for injuries where bruising is present or when there's tendon crepitus (swelling around a tendon sheath often causing a creaking sensation). Its mode of action is to inhibit the formation of fibrin which is associated with the development of crepitus. As well as keeping the gel against the skin and off the bed sheets, the glad wrap may reduce the amount of evaporation of the cream off the skin, providing a higher active dose at the injury site. The great thing about this treatment is that it's topical (i.e. doesn't have the same gastro side effects or liver stress of oral medication). The down side is that it only works well for superficial injuries - the deeper the injury (or the more fat you have over your injury site) the less effective this treatment will be.
Injuries I frequently recommend it for:
- Achilles, peroneal and tibialis posterior tendonitis (when acutely overloaded or when there's uniform tendon thickening or crepitus)
- FHL tenosynovitis
- Ankle sprains
- ITB syndrome (outer knee pain)
Don't use a heat cream like Deep Heat or Tiger Balm as part of a night wrap Caution: This is an off-label use of the above medication. Don't use if you've had a previous adverse reaction to either medication. Seek medical advice immediately if any adverse reaction occurs.