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Chapter 12322Second Phase (1-3 weeks postoperatively)Fig. 3: Cross-fingered exercise: The thumb and index finger are used to assist mouth opening.With the immediate inflammatory response subsiding after the first postoperative week, this second phase aims at further increasing the ROM, while increasing the muscle control and coordination and performance to achieve functional mobility. The number of exercises can gradually be increased to 5 to 10 daily and the number of repetitions can be decreased. This allows for a more ‘high-intensity endurance’ shift in rehabilitation. Pain therapy still plays an important role in this phase.(9,35,36) Cold application can be continued as a means to lessen joint pain (e.g., after certain exercises), and local moist heat application should be used as well. Heat application not only relieves muscle tension and pain, but also improves the extendibility of collagen fibers and decreases tissue viscosity, which can help when performing stretching exercises.(39,40) Furthermore, because local blood flow and metabolism are increased, tissue healing can become facilitated. The aim of this heat therapy is to achieve muscle relaxation; therefore, heat should be applied directly on the muscle - instead of on the joint - and should be used Nikolas de Meurechy NW.indd 322 05-06-2024 10:15