Exercises for Bell’s Palsy

Exercises for Bell’s PalsyBell's palsy affects an estimated 30,000 - 40,000 Americans every year, and it is most common in persons between the ages of 20 to 40 years, with higher incidences in individuals with diabetes mellitus and pregnant women.

Bell's palsy involves irritation to the seventh cranial nerve. Movement of the muscles of the face are controlled by this nerve, and when irritated could result in weakness or paralysis of the facial muscles. In most cases, only one side is affected, and the occurrence of left or right side palsy is approximately equal and remains equal for recurrences.

Causes of Bell's Palsy

The exact cause of Bell’s Palsy is likely due to reactivation of HSV herpes virus that causes cold sores, as viral and bacterial infections, as well as autoimmune disorders, are suspected to play a role. Herpes zoster infection, HIV infection, Lyme disease, middle ear infection, and Sarcoidosis are among some of the possible diseases which could contribute to Bell’s Palsy. 

Symptoms of Bell’s Palsy

The onset of paralysis is sudden with Bell’s palsy, and can worsen during the early stages. Symptoms will usually manifest and peak within 2-3 days, although it can take as long as 2 weeks. Common symptoms include, but are not limited to:

  • Muscle weakness or paralysis
  • Overall droopy facial appearance
  • Impossible or difficult to blink
  • Difficulty speaking
  • Difficulty eating and drinking
  • Nose runs
  • Nose is constantly stuffed
  • Forehead wrinkles disappear
  • Sensitivity to sound
  • Excess or reduced salivation
  • Facial swelling
  • Drooling
  • Diminished or distorted taste

There are also some eye related symptoms, which include but are not limited to:

  • Difficulty closing the eye
  • Sensitivity to light
  • Lower eyelid droop
  • Tears fail to coat cornea
  • Brow droop
  • Excessive tearing
  • Lack of tears

Exercises for Bell’s Palsy

While there is no high quality evidence to support significant benefit or harm from any physical therapy for idiopathic facial paralysis, there is some evidence that tailored facial exercises can help to improve facial function, mainly for people with moderate paralysis and chronic cases. There is also some evidence that facial exercises reduce sequelae in acute cases.

While cases vary, you are likely to deal with residuals such as: synkinesis, cross-wiring, hypertonic muscles, and spasms if you have suffered from Bell’s palsy for a longer time period. For some people, the muscles have had time to develop inappropriate movements. These movements must be unlearned, and correctly coordinated actions slowly relearned. Muscles that are holding other muscles captive have to be retrained in order to free-up other muscles to move correctly. 

The basic idea is to slowly recreate the brain-to-nerve-to-muscle routine. At first, the goal is to regain the capability of doing correct movements voluntarily, while mentally focusing on the action.

But over a period of time, these movements may finally become automatic, natural movements and expressions. While it is a slow process, performing the exercises below may be beneficial.

  • Sniffle, wrinkle nose, and flare nostrils
  • Curl your upper lip up, and then raise and protrude the upper lip
  • Try to smile without showing teeth, then smile showing teeth
  • Using your index finger and thumb, pull the corners of your lips in toward the center. Slowly and smoothly push out and up into a smile. Continue the movement up to the cheekbone. Use a firm pressure
  • Try to close the eye slowly and gently, without letting your mouth pull up or your eyebrow move downward
  • Try to raise your eyebrows, and then hold for 10 -15 seconds. Pause, and repeat.
  • Gently wink with one eye, and then try the other one. Do it to the best of your ability, and do not push it.
  • Open eyes widely, but without involving your eyebrow. Stop if you see any inappropriate muscle actions.

For more detailed information on helpful exercises, physical therapy, and treatment options, schedule a consultation with Beverly Hills Bell’s palsy expert Dr. Azizzadeh by calling 888.499.0402 today!

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Director, The Facial Paralysis Institute - Associate Clinical Professor - Facial Plastic & Reconstructive Surgery David Geffen School of Medicine at UCLA

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Dr. Azizzadeh’s facial nerve textbook is the preeminent textbook for doctors on the subject.