Bell’s Palsy: Physical Therapy Guide & Tips!

What are the different types of facial palsy and their diagnosis?

There are two main types of facial palsy:

1. Central facial palsy, often caused by a stroke. It is called central because it is due to a problem in the brain, which is the center of the nervous system.
2. Peripheral facial palsy: It is called peripheral because it is due to damage to the facial nerve, located in the periphery of the brain.

Bell’s palsy, also known as idiopathic acute facial palsy, is the most common form of peripheral facial palsy, and it is the one we will discuss in this article.

It can affect the right or left side of the face, causing paralysis of half of the face. That’s why it is sometimes referred to as facial hemiplegia.

Sometimes the terms central or peripheral facial paresis are used instead of palsy when the nerve damage is less severe, and the muscles are partially paralyzed.

In general, a simple interview combined with a clinical examination by a general practitioner can differentiate between central and peripheral facial paralysis and determine if it is Bell’s palsy or not. In case of uncertainty, the patient may be referred to an ENT specialist or a neurologist who can conduct further tests.

It is important to determine whether the palst is of central or peripheral origin because the medical and physiotherapy treatments may differ in certain aspects. It also helps in understanding the expected recovery time of the facial palsy and whether there is a risk of long-term effects.

What are the signs of Bell’s palsy (peripheral facial palsy)?

The early signs of Bell’s palsy are often as follows:

1. A fairly strong pain behind the ear.
2. Sudden onset (within 48 hours) of weakness in the muscles on one side of the face, resulting in noticeable facial changes even at rest.

What are the causes of Bell’s palsy?

The exact causes of this type of facial paralysis are not known with certainty.

The most likely hypothesis today is that it is often a reactivation of the herpes virus (also responsible for chickenpox and shingles). The virus would localize itself on the facial nerve, triggering inflammation of the nerve, which leads to pain and paralysis.

Most often, the cause of Bell’s palsy is viral. Since the virus is localized within the nerve, it is not contagious. There is no risk of transmitting either the facial paralysis or the virus to someone else in any way.

Stress is often implicated as a trigger for Bell’s palsy. It is observed that anxious people are more prone to developing this facial paralysis, but it is also noted that people with the paralysis are more likely to develop anxiety. Currently, it cannot be definitively stated that stress is directly or indirectly responsible for this facial paralysis.

This facial paralysis is most commonly and probably caused by a virus.

What is the recovery time of Bell’s palsy?

Once diagnosed with Bell’s palsy, the most common question people have is how long the facial palsy will last and when their face will return to normal. Fortunately, we have reassuring data:

• 71% of people achieve complete recovery (94% for those with incomplete paralysis and 61% for those with complete paralysis), meaning they have no lingering effects. The risk of long-term complications after Bell’s palsy is low.
• The majority of people begin to recover within 7 days of the onset of palsy. The faster the paralysis starts to fade (within the first week), the higher the chances of complete recovery (88% in such cases).
• If signs of recovery appear within 2 weeks, the chances of complete recovery are 83%, and they are 61% if symptoms begin to regress only after 3 weeks.
• Some people fully recover without treatment, although treatments (mentioned below) increase the chances of complete or faster recovery.

In general, the recovery time of Bell’s palsy is around 3 weeks, rarely lasting 4 to 6 months.

What is the treatment for Bell’s palsy?

Here is what is often implemented when dealing with this condition.

Medications for Bell’s palsy

Taking corticosteroids (under medical prescription) increases:

• The chances of complete recovery from Bell’s palsy.
• Reduces the risk of debilitating aesthetic sequelae compared to taking a placebo or receiving no treatment.

Don’t worry if you haven’t received this treatment; you can still recover well!

Most people recover spontaneously within 3 weeks (BMJ 2014).

To maximize the treatment’s success, corticosteroids should be initiated within 48 hours of the onset of facial palsy.

Analgesics may also be prescribed for pain relief in the ENT area (headache, earache, jaw pain). They are meant to alleviate pain but not to accelerate or improve the chances of recovery.

Does physical therapy help bell’s palsy?

Since at least the 1990s, physical therapy sessions have often been prescribed to individuals with Bell’s palsy.

In theory, physical therapy helps strengthen weakened muscles and reawaken the nerve motor control of paralyzed muscles. It also reassures the patient about the natural progression of the condition, which can be a source of anxiety due to its functional and aesthetic consequences.

Physical therapy sessions always begin with an assessment. This allows for the precise identification of the affected muscles to better select appropriate exercises. It also helps reassure the patient about the extent of their condition.

Do people undergoing physical therapy recover more or faster than others? There is limited data on this, as is often the case with physical therapy. Only the use of electrotherapy has been relatively well-studied. Studies show that people treated with electrotherapy do not recover faster or better than others, nor do they have fewer sequelae.

What is the physical therapy for bell’s palsy?

The physical therapy approach involves practicing facial muscle exercises multiple times a day.

Certain muscles will be more targeted than others as they recover less easily. This is the case for the buccinator muscle, which is responsible for keeping food in the mouth and chewing properly. On the other hand, the zygomatic muscles, responsible for smiling, will be less targeted as they tend to recover spontaneously and may hinder the recovery of the buccinator muscle.

The patient independently performs the exercises in addition to the therapy sessions. The sessions are meant to monitor progress, ensure proper execution of the exercises, and adapt them based on progress.

Initially, it may be challenging to contract the muscles analytically, meaning one by one rather than all together. Physical therapists are there to guide the patient in achieving this to make the rehabilitation more effective. For example, it is important to prevent the eyes from closing when performing the “puckered lips” mimic.

The frequency of sessions ranges from one to three times per week, depending on the severity of the condition and the patient’s ability to perform the exercises. The duration can span from 3 to 6 weeks, rarely extending to a few months in cases of more severe facial paralysis.

Bell’s palsy physiotherapy exercises (video)

In response to numerous requests, here is a video demonstrating a series of 3 exercises for Bell’s palsy. Remember to adapt them based on the individual assessment conducted during physical therapy.

3 possible exercises to perform in cases of peripheral facial palsy are:

1. Brow Lift Exercise: Place your fingertips just above your eyebrows. Gently apply upward pressure while trying to raise your eyebrows. Hold for a few seconds, then release. Repeat this exercise several times.
2. Cheek Puff Exercise: Take a deep breath and puff out your cheeks as much as possible. Hold for a few seconds, then slowly release the air. Repeat this exercise several times.
3. Lip Corner Pull Exercise: Place your index fingers on the corners of your mouth. Gently pull the corners of your mouth toward your ears, creating a smile shape. Hold for a few seconds, then relax. Repeat this exercise several times.

Precautions to take

Depending on the degree of facial palsy, the eye may have difficulty closing. To prevent it from drying out, artificial tears may be prescribed, in addition to an eye patch.

Protective eyewear should also be worn more than usual when working in dusty conditions.

Are there any natural treatments?

There is no evidence that certain treatments often categorized as natural (homeopathy, acupuncture, hypnosis, magnetism, herbal therapy, etc.) accelerate healing or increase the chances of complete recovery.

People treated with acupuncture for their peripheral facial paralysis do not recover faster or better than those without acupuncture.

Case study of patient with facial palsy

Mr. N, 40 years old

One morning, Mr. N woke up with half of his face paralyzed. It was a Bell’s palsy. His doctor referred him to the ENT department of the city hospital. The ENT specialist prescribed an MRI, physiotherapy sessions, corticosteroids, and artificial tears for the eyes.

Mr. N scheduled an appointment for the physiotherapy sessions, which began three weeks after the first symptom.

During the initial assessment, Mr. N was worried as his paralysis did not improve. He had difficulty chewing and all areas of his face were affected: forehead, nose, cheeks, and mouth. He was greatly concerned about the aesthetic aspect. Anxious, he took time off from work. He experienced significant pain, especially worsened at night, behind the ear. Above all, he was worried whether the paralysis was a symptom of a more serious problem like cancer.

Three objectives were defined:

1. Reassure Mr. N about the course of the disease and the high probability that it was not associated with other health issues.
2. Advise Mr. N on ways to alleviate his pain (e.g., sleeping with the head slightly elevated).
3. Teach Mr. N active self-rehabilitation exercises and their proper execution.

During the first session, Mr. N learned five exercises that he was instructed to perform three times a day, with 10 repetitions each.

Three days later, a follow-up physiotherapy session was scheduled. Mr. N was performing his exercises correctly, and three additional exercises were added. He experienced much less pain, but the paralysis remained as pronounced as before.

Four days later, the third session took place. This time, the facial paralysis had significantly regressed and was no longer visible to someone unfamiliar with the condition. Mr. N was able to eat almost normally. He felt reassured and decided not to schedule his MRI.

A final session, one week later, confirmed the near-complete disappearance of the Bell’s palsy. The exercises could now be continued autonomously until full recovery of facial mobility and symmetry.

How to find a physiotherapist specializing in facial palsy?

Physiotherapists are generally trained in physiotherapy schools to manage central or peripheral facial palsy. Therefore, you can contact any physiotherapy clinic or a home-based physiotherapist.

However, some physiotherapists choose to specialize further in the management of these conditions. These are often physiotherapists specialized in maxillofacial rehabilitation.

These physiotherapists have undergone specific continuing education focused on the management of these conditions, or have self-trained in this field.

To find them, you can:

• Ask your general practitioner or ENT specialist if they know any in your area.
• Search “physiotherapist facial paralysis” in your search engine or Google Maps to see if it provides you with any results.

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Here’s what I wanted to tell you about this! I wish you a very good recovery! Do you have any comments or questions? Your comments are welcome 🙂 !

You may also like:

• Facial Droop After Stroke: Recovery Time
• My blog on physical therapy & health

 📚 SOURCES

Teixeira LJ, Valbuza JS, Prado GF. Physical therapy for Bell’s palsy (idiopathic facial paralysis). Cochrane Database Syst Rev. 2011;(12):CD006283. Published 2011 Dec 7. doi:10.1002/14651858.CD006283.pub3

Tseng CC, Hu LY, Liu ME, Yang AC, Shen CC, Tsai SJ. Bidirectional association between Bell’s palsy and anxiety disorders: A nationwide population-based retrospective cohort study. J Affect Disord. 2017;215:269-273. doi:10.1016/j.jad.2017.03.051

Holland NJ, Bernstein JM. Bell’s palsy. BMJ Clin Evid. 2014;2014:1204. Published 2014 Apr 9.

Examples of exercices CHU Montpellier : here