top of page

Night Wrap Protocol for Tendinopathy and Tendon Pain

Updated: Apr 2

This is an updated version of the blog first written in October 2025.

I shad a client come and see me with pain in their Achilles tendon, which wasn't settling - therefore they were not able to start loading it to make it easier to function. They were pretty stuck, and every morning their Achilles was too sore to walk on until they warmed up. I had just listened to Ebonie Rio, Physiotherapist with a special interest in tendons, and she had talked about the "Night Wrap", a combination of Hirudoid Cream and Voltaren gel, applied at night.


They used it, and their morning pain was less, they were able to move more and then they were able to start loading it (which is always the goal for a better life).


It's not a magic cure and isn't going to suddenly increase the capacity of your tendon to take load. But, what it can do, and I recommend doing this in conjunction with a targeted strength programme, is to decrease the pain enough to start loading, or to allow higher loading and less morning pain in the tendon.


The recommended way to use it:

  1. Massage in to the sore area some hirudoid and voltaren until it's absorbed

  2. Next, apply a large quantity of roughly equal portions of hirudoid and voltaren

  3. cover with glad wrap overnight

  4. use a gauze pad if it's on a bony area to stop it sliding around

  5. repeat nightly for 2-3 weeks.


Why We Use It For Tendon Pain and Tendinopathy


When you have tendon pain and tendinopathy, there is a LOT going on in the area. Increased blood flow (not in a good way) with increased blood vessels that bring with them nerve endings, disorganised collagen, and an inability to load the tendon without pain. We want to improve tendon pain or tendinopathy with physiotherapy, but there are lots of other things that can help too. This is an over the counter treatment. The theory is that the wrap helps calm down irritated tendons or sore joints/muscles by improving circulation, reducing inflammation and supporting healthy tissue repair while you rest. The reality is that most people do feel better afterwards.


We know that Voltaren gel is deeply penetrating is has anti-inflammatory.


Hirudoid helps collagen organisation in healing at all stages of healing - plus other benefits.


It's thought that voltaren gel supercharges the hirudoid - that is, it takes the hirudoid with it as it penetrates into the tissue. .


Our understanding is that it's most useful for tendon pain, overuse irritation, or post-activity soreness (e.g. elbow, knee, Achilles).


There has been no research on whether this combination is scientifically valid. Anecdotally I've used it on more than 30 clients. One was worse (the doctor couldn't work out why, as they had no history of reactions, and there was no reason for it), 1-2 found it didn't really change anything. Everyone else has found it helpful.

Important Note


I’m not able to prescribe medications — this is an over-the-counter option only.


Before starting, please check with your pharmacist that both creams are appropriate for you, especially if you’re sensitive to diclofenac, aspirin, or other anti-inflammatory gels.


person holding knee as if it's sore
person holding knee as if it's sore

What You’ll Need


✅ Voltaren® Gel (diclofenac 1%) – anti-inflammatory pain-relief gel.


✅ Hirudoid® Cream – helps with tissue healing and collagen organisation.


✅ Cling wrap (Glad Wrap) – keeps the cream in contact overnight.


All are available without a prescription from your local pharmacy. These are over the counter medications, but if you have previously had a reaction, then this is obviously not recommended. I cannot prescribe.



How to Do It


  1. Mix a decent amount of Voltaren gel and Hirudoid cream together (about a teaspoon each).


  2. Apply a thick layer over the sore area – do not rub it in. It's like a poultice.

    Here's where my clients have found they can stop - some have sensory issues, some don't like feeling like a petrol-station-sandwich overnight.

  3. What they do is place a thick layer on, let it soak in, when they need to go to bed they rub it in and call it good. NB(It's probably not as good as following the rest of the steps, but in our experience, it's better than not doing it. Also for hips and shoulders, it's not very comfortable to put plastic on, but each to their own.)


  4. Wrap loosely in Glad Wrap to stop it going everywhere. The "mini" camping size gladwrap is easier to wrap around joints.


  5. Leave it on overnight, then wash off in the morning (or, leave it)



How Often


  • Use once nightly for up to 2 weeks. (or if you are home, twice a day).


  • After 2 weeks:

    • Take a 1-week break, or

    • Continue with Hirudoid only if it still helps.

    • You can then start again after one week, with the same brew.


  • Avoid using Voltaren gel for more than 2 weeks in a row (that's what it says on the tube)



Extra Tips


  • Don’t apply to broken skin or wounds.

  • Keep away from pets (Voltaren can be toxic if eaten).

  • If it stings, burns, or makes the pain worse, stop and check in with your GP or pharmacist.

  • Use it after long or high-load days to help reduce next-day stiffness.



What to Expect

dark haired woman with hand up saying stop
dark haired woman with hand up saying stop


💡 Less morning stiffness or swelling after a few nights.

💡 Better comfort with everyday activity and loading exercises.


When to Stop


❌ If the area becomes hotter, redder, or more painful.

❌ If you develop a skin reaction or any unusual discomfort.

❌ If your pharmacist or doctor advises against using either cream. SDS US Voltaren Safety Data Sheet


 
 
 

Comments

bottom of page