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Postoperative physiotherapy31912transient traumatic arthritis, independent of the type of joint pathology. As a result, irritation of the synovial membrane will occur, which will lead to joint effusion and result in reflex muscle splinting as a mechanism to protect the joint. In response, the patient will tend to immobilize the joint to avoid any painful movement.(16,31) However, as has clearly been shown by the studies included in this review and many other studies, this immobilization has been found to be detrimental to the joint, resulting in degenerative changes to the joint and changes in the fibrous structure with the formation of scar and adhesion as the connective tissue starts to heal. Due to the ensuing immobilization, synovial fluid dynamics become impaired with the resulting decreased intra-articular lubrication.(5,32,33)Table 8. Proposed revalidation schedule.Phase Timing Therapy1 Within 24 hours after surgery to 7 days after surgeryNonchewing dietCold therapy over joint 1×20 minutes, (minimally) 5 times per dayCondylar rotational exercises (passive opening and closing, 20 repetitions, 3 times per day; active opening and closing, 20 repetitions, 3 times per day)Grade I joint distractionGrade II joint distraction toward end of phase 1Oral reeducation with avoidance of parafunctions2 From 1 to 3 weeks after surgerySoft dietMoist heat application over muscles 20 minutes before exercises, cold application over joint after exercisesCoordination exercise using a mirror1. Condylar rotational exercises as in phase 12. Active mouth opening and closing3. “Mandibular snake”: protrusion, depression, retrusion, elevation, return to neutral positionRange of motion exercises (until pain limit, not over pain limit)1. Insertion of tongue spatula or TheraBite system 7x7 seconds, 7 times per day2. Active assisted opening: 10 repetitions, keeping the maximal mouth opening for 30 seconds, 3 times per day3. Active lateral movement: 10 repetitions keeping the maximum lateral deviation for 30 seconds, 3 times per day4. Active protrusive and retrusive movement: 10 repetitions, keeping the pro/retrusive deviation for 30 seconds, 3 times per dayGrade II joint distractionUse of chewing gumNikolas de Meurechy NW.indd 319 05-06-2024 10:15