Fascial Adhesion After ACL Surgery: Why It Happens and How to Treat It Safely During Rehab
- Nick Lane
- 3 days ago
- 4 min read
Proview Sports Cheltenham Sports Injury Clinic | Cheltenham ACL Rehabilitation Specialists
Discipline Focus: Sports Therapy & Massage
Recovering from ACL surgery takes patience, structure and the right guidance. One of the most common issues we see with clients across is fascial adhesion.
Even when your graft is healing well, the tissues around the knee can become tight, sticky and painful, making the joint feel blocked or restricted. This can slow your progress if it’s not managed properly.
In this blog, we’ll explain what fascial adhesions actually are, how they form after ACL surgery, and the treatment strategies we use at Proview Sports to help athletes regain comfortable movement, strength and confidence.
What Are Fascial Adhesions?
Fascia is a thin, strong layer of connective tissue that surrounds and supports your muscles, tendons, nerves and ligaments. When it’s healthy, fascia is elastic, hydrated and allows everything to move freely.
After ACL surgery, the fascia around the knee often becomes:
sticky or “glued down”
less elastic
sensitive to pressure
restricted in how it slides over the quadriceps, IT band, hamstrings and joint capsule
These changes are called fascial adhesions, and they can create that familiar feeling of tightness, pinching or “something catching” inside the knee.
Why Fascial Adhesions Develop After ACL Surgery
ACL reconstruction is a major procedure, and the early healing environment is the perfect storm for fascial restriction. The main reasons include:
1. Surgical trauma and scar formation
Incisions, graft harvest sites and portal scars all create local inflammation. As the tissue heals, some fascia can bind to deeper layers.
2. Reduced movement in the early phase
Protecting the knee initially is important — but reduced loading and limited mobility allow fascia to become dry and stiff, making adhesions more likely.
3. Swelling and fluid build-up
Inflammation increases tissue pressure and reduces sliding between layers. Persistent swelling is one of the biggest contributors to fascial tightness.
4. Inhibited quadriceps and hamstring function
After ACL surgery, the quadriceps often “switch off” due to pain and nerve inhibition. This leads to altered movement patterns and increased fascial tension.
5. Protective movement habits
Limping, guarding and avoiding certain positions change the way your tissues load and glide — which can reinforce tightness.
Common Signs of Fascial Adhesions After ACL Surgery
Many people assume something is wrong with their graft, when actually the fascia just needs targeted work. Typical symptoms include:
Tightness at the front of the knee or around the kneecap
Pulling or pinching during squats, stairs or cycling
Difficulty achieving terminal knee extension
A “block” stopping deeper knee bending
Sensitivity around graft sites
A stiff band-like feeling along the IT band or quad
Clicking or catching caused by soft tissue, not the joint
Discomfort with kneeling or lunging
These signs are extremely common, and in most cases, very treatable.
Where Fascial Adhesions Commonly Form After ACL Reconstruction
We regularly see fascial restriction in the following areas:
1. Around the patella (kneecap)
This affects knee extension, quad strength and confidence in walking.
2. Quadriceps muscle and tendon
Especially after a patellar tendon or quad tendon graft, leading to pulling or sharp tension.
3. Hamstring graft site
Deep tightness with bending, sprinting progression or hamstring activation.
4. IT band and lateral thigh
Can cause discomfort when running or during lateral movements.
5. Small portal incision scars
Tiny scars can restrict surprisingly large ranges of movement if not mobilised correctly.
How Fascial Adhesions Affect Your ACL Rehab
If adhesions aren’t addressed, you may experience:
slower progress with range of movement
difficulty regaining full extension or flexion
reduced quadriceps activation
stiffness during closed-chain strength work
ongoing swelling
discomfort with running or change of direction
delayed return to sport
This is one of the most common reasons people feel “stuck” at 6–16 weeks post-op.
The good news: with the right approach, fascial mobility can improve quickly.
How We Treat Fascial Adhesions at Proview Sports
Cheltenham Sports Therapy & Online ACL Rehab Support
Our approach combines hands-on therapy, structured loading, and evidence-based ACL rehabilitation. This ensures tissues don’t just loosen — they learn to move properly again under strength and control.
1. Specialist Manual Therapy
We use targeted, comfortable hands-on techniques to restore fascial glide and reduce pain, including:
myofascial release
soft tissue mobilisation
instrument-assisted techniques
scar tissue remodelling
dry needling (when appropriate)
These help restore movement and reduce that tight, pinching sensation around the knee.
2. Guided Movement & Mobility Work
We teach you safe and progressive mobility drills that:
improve patella mobility
restore full extension
build deeper flexion gradually
improve synovial fluid movement
reduce stiffness in and around graft sites
Movement is essential — it keeps fascia hydrated and responsive.
3. Swelling & Recovery Management
Since swelling plays a major role in fascial tightness, we often integrate:
compression
cryo-compression units (See our Home Rental Service Here)
lymphatic flow exercises
decongestion strategies
Reducing swelling often creates an immediate improvement in stiffness and movement.
4. Strength Training Through New Ranges
Once fascial mobility improves, we reinforce it with:
quadriceps activation
hamstring loading
closed-chain strength
early plyometrics (when appropriate)
balance and neuromuscular work
Strength through range prevents adhesions from reforming (Supported by our Physio Services )
When To Seek Support & Add Manual Therapy & Massage To Your Rehab
It may be time to see a one of our physios or complement your rehab with our highli skilles sports therapists & massager if:
you’re more than 4–6 weeks post-op and movement feels stuck
extension is limited despite good physio work
bending feels blocked, sharp or restricted
swelling keeps returning
you’re unsure what’s normal vs. what needs attention
you want a structured plan built around elite ACL rehab processes
Fascial adhesions are extremely common, but they shouldn’t hold you back.
ACL Rehabilitation in Cheltenham — Or Fully Online
Proview Sports specialises in complete ACL rehabilitation, supporting athletes from day one post-op all the way to return to sport.
We offer:
advanced sports therapy
manual therapy for post-operative knees
strength programming
swelling management
ACL-specific testing
return-to-sport preparation
online rehab support for athletes nationwide
Whether you're based in Cheltenham or looking for expert online support, we help you rebuild strength, movement and confidence — properly.
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