The Night Wrap - a way to reduce swelling?

March 7, 2017

I'm going to start by stating that this is in no way a recommendation to any one reading this blog to try. Please don't do this unless advised by your healthcare professional. 



To start with, I'll give you a little bit of a background to how I was introduced to the 'night wrap'. 


For around 3 years now I have been suffering with right ankle pain and stiffness, that on the whole is quite annoying. It began with the occasional painful click in the front of my ankle, then slowly developed into a lack of dorsiflexion. From here I began to develop considerable pain after prolonged weight bearing on my ankle to the point where manual therapy wasn't helping at all!


At this point I was sent for an X-Ray where it was found that I had developed anteromedial tibio-talar impingement spurs. These were treated by surgical athroscopic debridement (shaving down the bone spurs), which I hoped would be the end of my worries.




Following this I was placed into the care of Podiatrists, which is where I was introduced to the 'night wrap' as part of my treatment plan. Along with this I was receiving Osteopathic treatment, doing rehabilitation exercises and generally trying to get my ankle moving again...




So what even is it and how does it work?


Essentially the night wrap is a combination of topical Ibuprofen and Hirudoid cream. You liberally slap both creams on to the affected area and wrap them up in cling film, before getting into bed and getting to sleep. 


The idea behind it is that by leaving a sustained large dose of both creams on overnight, they should have a good 6-8 hours to affect the area. The Ibuprofen gel will act as an anti-inflammatory, with the addition of Hirudoid cream supposedly helping reduce any bruising or tendon crepitus due to it's inhibition of fibrin production. 




You apply this for 3-4 nights in a row, and for me I was told to also apply it every night after exercising in a way that created high impact forces on my ankle. 


The reason it's wrapped in cling film is purely to stop the creams/gels going all over your bed, and to stop it evaporating leading to that sustained higher dose. 


Based on how long I had had by ankle problem for and the plateau I had reached in my recovery, I thought it was worth a shot, even if the evidence is all anecdotal and it's an 'off-label' use of both products. 


What do you use it for?


Apparently, the night wrap is good for a lot of foot/ankle conditions including;

  • Achilles tendinitis

  • Tibialis Posterior tendinitis

  • Flexor Hallucis Longus tenosynovitis

  • Ankle sprains

Essentially it is supposed to be effective for more superficial injuries, that generally have a more acute inflammatory component to them.




So, does it work?


In short, no. 


I followed the protocol for a couple of months as I stated above. For 4 nights in a row and then every night on the days where I had exercised in a way that had put impact forces through my ankle. 


I found that after a couple of months, the swelling didn't reduce each morning after using the night wrap. Even after applying it for 4 nights in a row initially, there was little to no change in swelling. It then caused my skin where I had applied the creams to dry out, so I decided to stop doing it.


I went back to basics and focused on stretching, strengthening and mobilisation exercises for my foot, ankle, knee and hip. I started doing these more and more each day, and found that after exercising and with occasional treatment to help massage local soft tissues around the ankle and to also aid with improving mobility, I had much better results.



So what did I learn?


Firstly, I have to say that other posts I have read about night wrap have shown positive results. So it may well have been something that I did wrong such as;

  • Not used enough of either of the creams/gels

  • Used the wrong topical anti-inflammatory cream (maybe a diclofenac based one would have been more effective)

  • Not giving the protocol enough time to work

The reported effectiveness in other cases may purely be down to a placebo effect leading to a reduction in pain symptoms.


With this said I do think that based on my experience, and what I would advise in practice, that sticking to a more traditional manual therapy programme accompanied with a tailored progressive exercise programme will be a lot more effective than the 'night wrap'.





It's important for me to say again that in no way am I advising anyone reading this blog to use the 'night wrap' as a treatment protocol. It is always best to seek the advice of a health care professional for the treatment, rehabilitation and recovery from injuries and ailments. 



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