Bell’s Palsy Physical Therapy Exercises – Facial Palsy (Drooping Face)

Bell’s Palsy or facial palsy is the drooping of one or both sides of the face. It causes significant changes in appearance and impairs the chewing and swallowing of food.

Physical therapy, exercises, acupuncture, and medications are all helpful in relieving the symptoms.

What is Bell’s Palsy?

Bell’s Palsy is the weakness of the facial muscles. it is usually sudden in onset and mostly affects one side of the face. It causes drooping of the face.

Bell’s palsy is also called facial palsy since it is due to injury or a disease process affecting the facial nerve.

It may not be complete paralysis and it alternates between weakness spasms & paralysis of some or all of the muscles supplied by the facial nerve.

Causes of Bell’s Palsy:

The precise cause of Bell’s Facial Palsy is not known. Inflammation of the facial nerve is thought to be responsible for the disease. Inflammation may be caused by:

• Viral infections (Herpes Simplex),
• Trauma (as may occur following a facial or parotid gland surgery),
• Sudden changes in the temperature,
• Diabetes,
• Connective tissue diseases such as SLE, RA (Rheumatoid arthritis), vasculitis, and Sjogren’s syndrome.

Symptoms generally begin to improve within a few weeks, but a complete recovery is expected in almost 6 months.

Complete recovery occurs in a few percentage of patients especially those with mild facial weakness. Others may have residual symptoms lasting their whole lives.

Among the famous celebrities, Angelina Jolie reported facial palsy after she split from Brad Pitt in 2016/17. Stress is one of the causes of Bell’s palsy.

Some people blame cosmetic procedures like BOTOX Injections as the cause of Bell’s palsy in her case.

What are the symptoms of Facial Palsy?

The facial nerve controls muscles responsible for facial expressions, eye closure, taste sensations in the tongue, and some of the muscles in the ear.

Therefore, symptoms can vary according to the nature of innervation, but may include:

• Loss of facial movements on the affected side of the face
• Pain in the region of the affected side of the face, although pain is usually not a feature.
• Inability to close the eye of the affected facial nerve.
• Inability to move the lips of the affected side such as difficulty blowing.
• Increased sensitivity to the nose, and pain in the ear, and around the jaw, but these symptoms resolve quickly.
• Drooping of the eyelid or angle of the mouth of the affected side of the face.
• Loss of facial expressions, i.e. raising the eyebrows, frowning, smiling, blowing, whistling, etc.
• Lack of ability to drink or chew. Patients tend to chew on the opposite side and food gets stuck on the affected side which is then cleared with a finger. Drooling of water and saliva may also occur on the affected side.
• Difficulty speaking because of involvement of speech muscles
• Frequent episodes of headaches
• The risk of eye infection is increased because of decreased ability to blink an eye or lack of eyelid opening and closing
• Depression, anxiety, and social phobia may occur as a result of the facial asymmetry
• Decreased taste sensations on the affected side
• Altered tear or saliva production.

When to see a doctor for facial palsy?

Seek immediate medical help if you experience any type of symptoms including tingling, numbness, or paralysis because there are chances of having a Stroke. However, Bell’s palsy is not caused by a Stroke.

See your doctor if you experience facial weakness or drooping to determine the underlying cause and severity of the illness.

How to differentiate between Bell’s Palsy and stroke?

Strokes can also cause facial muscle weakness. Isolated involvement of the facial muscles is extremely rare in stroke. Since stroke is due to reduced blood supply to the brain, other features may also be present in patients with stroke.

Some of the differentiating features include:

• If you have limb weakness associated with facial drooping, always consider stroke as the diagnosis and seek medical care. Weakness can occur on the same or opposite side.
• If facial drooping is associated with a hearing problem or difficulty moving eyes from side to side, or there is a concomitant loss of consciousness or seizures, always consider a diagnosis other than Bell’s palsy.
• If you look up and wrinkling of the forehead is absent on the affected side of the face, this is Bell’s palsy. If not, consider stroke as the diagnosis.

Risk Factors for Bell’s Palsy:

• Pregnancy, especially those having the third trimester, or the first week after childbirth.
• If you are having an upper respiratory tract infection, such as the Flu or a cold
• If you’re Diabetic
• In some cases, there may be a genetic cause of Bell’s palsy.

What complications may arise as a result of Bell’s Palsy?

Complications may include:

• Irreversible damage to your facial nerve
• Mislead nerve fiber regrowth, causing involuntary contraction of certain muscles when trying to move others; For example, if you smile, the eye on the affected side may not move.
• Partial or total blindness of the eye that does not close due to excessive dryness and scratching of the cornea, the transparent protective covering of the eye.

How to treat Bell’s Palsy?

• Maintain eye protection, using eye drops or lubricants, ointments, etc. thus keeping the eye protected from catching foreign body infections.
• Muscle and nerve stimulation via electrotherapy and exercise techniques can improve symptoms.
• Acupuncture can help treat the symptoms and improve the condition.
• You can perform Relaxation therapies and strategies to reduce stress factors
• Surgery (a rare last option, appropriate only for very specific cases, usually ones due to facial trauma

Consult Your Doctor as Early as Possible:

• Initially, you’re advised to visit a family doctor for proper diagnosis and initial medical treatment, however, sometimes when you call to book an appointment you’re directly referred to have an appointment with a neurologist.

Here are some tips you need to follow before visiting any doctor or consultant.

• Write down all the symptoms you’re suffering from. Make sure to note down all the symptoms or queries that you think, are not related to the problem for which you’re making an appointment.
• Write down all your important personal information. Have you had any major stresses or life changes recently? Sharing this type of information may prove quite helpful to your doctor to make a final diagnosis.
• Make a complete list of the entire medications you’re taking including dosage and don’t forget to mention any supplements, minerals, or vitamins you have been taking so far.
• Make sure to visit your doctor with your family member, so that if you’re missing any information that is necessary to mention in front of your doctor, your companion will help to mention the key points of your condition.
• Write down all the questions and queries you want to ask your doctor.

What do you need to discuss?

1. What’s the most possible cause of my symptoms?
2. Is there any other possible cause for my symptoms?
3. What tests are necessary for an accurate diagnosis?
4. Is the condition reversible or permanent?
5. What possible treatment options are available for Bell’s palsy? Which treatment options do you advise?
6. I have other health conditions. How can I best manage these conditions together?
7. Do you have broachers or printed information that is necessary to follow in my daily life?
8. What websites would you recommend?

Don’t hesitate to ask any additional questions that are arising in your mind during your consultation.

Clinical signs you can check to diagnose facial Palsy:

There are no specific diagnostic tests for bell’s palsy, however, your doctor will ask you to perform multiple actions, including

• Show your teeth
• Blow air
• Do frowning
• Raise your eyebrows
• Close your eyelids
• Try to smile etc.

Imaging scans may be advised by your doctor include:

• Magnetic resonance imaging (MRI) or computerized tomography (CT) are performed to rule out any other possible causes of facial nerve damage, including tumors or skull fractures, etc.

An NCS (Nerve conduction studies) may be advised. This test is done usually in patients with GBS (Guillain Barre’s Syndrome) and Bilateral Facial Palsy.

Treatment of Bell’s Palsy:

Most people recover from bell’s palsy with or without treatment or medications. However, your consultant will initially prescribe some medications in order to stimulate a rapid recovery.

Your doctor will highly suggest you take physiotherapy sessions in order to get a complete recovery. Surgery is a rare and last option that is advised only if you are not having any improvements even after medication or physiotherapy.

Medicines that are used to treat Bell’s Palsy:

Common medications that are used to treat bell’s palsy include:

• Corticosteroids, such as prednisone. These are strong anti-inflammatory drugs. They can reduce facial nerve swelling. Corticosteroids may work best if you start taking them immediately after the onset of symptoms, preferably within 24 hours of symptoms onset.
• Antiviral medicines may help reduce the severity of the disease. They are less likely to help patients with mild diseases.
• Valacyclovir in combination with prednisone has been studied in patients with bells palsy. It reduces the severity and duration of the disease.

Lifestyle modification and home precautions for Bell’s Palsy:

• Protect your affected eye with lubricants or eye drops during the daytime and using an eye ointment at night will help keep your eye moisturized. It is suggested to use sunglasses during the daytime or sunlight and an eye patch at night to prevent getting an eye infection in the opened eye.
• Initially take some painkillers to settle your pain. Aspirin, ibuprofen, or acetaminophen may help relieve your pain.
• Apply deep moist heat on your eye with a towel soaked in warm water and keeping it on your affected eye will give you a pain-relieving effect.
• Perform physiotherapy exercises regularly as prescribed by your physiotherapist. Doing gentle massages and exercises guided by your therapist on your face may induce relaxation in your facial muscles.

Importance of Physiotherapy for Bell’s Palsy?

According to research, almost 70% of patients suffering from bell’s palsy recover in about 6 months, however, 30% of people are still left with few symptoms thus recovery is not fully accomplished.

• Physiotherapy has an imp role in increasing the flexibility of the facial muscles thus improving blood circulation to the affected muscles.
• Physiotherapy plays role in reducing tension in neck musculature that develops due to the facial paralysis
• Education on facial exercises is necessary to perform repetitions at home to not only increase muscle flexibility but also strengthen facial muscles.
• Acupuncture therapy is also helpful in stimulating paralyzed muscles.
• Physiotherapy techniques generally provide sensations to paralyzed muscles helping them to regain their activity.

Importance of Exercises for treating Bell’s Palsy:

All exercises that are guided to you by your physiotherapist are quite helpful in regaining muscle strength and coordination. Exercises help you to regain muscle power to the optimal range.

All exercises need to be repeated at least 3-4 times a day with 2-3 sets in each session. Before starting any exercise it’s necessary to do a warm-up session for facial muscles to improve blood circulation.

For facial exercises, it is recommended to do all facial exercises in front of a mirror so that your brain feeds the desired movement patterns.

You don’t have to overwork them because they are already weak. Initiate your exercise program in a lying position gradually progressing to a sitting position.

Step 1

Start your workout by gently moving each muscle in your face.

Step 2

Try to slowly and gently lift the affected eyebrows while sitting in front of a mirror with the help of your fingers. Avoid putting too much pressure on the affected side.

Step 3

Use your fingers to gently massage different areas of your face, e.g. B. Forehead, cheeks, corners of the mouth, etc. Muscles can affect the strength and flexibility of the entire face.

Bell’s Palsy Physical Therapy Exercises:

After completing a warm-up session, gently begin exercise on your nose and cheek regions as any weakness or paralysis of these muscles can affect the strength and flexibility of the whole face.

Raising Brows:

• What you need to do is simply place your finger on the top of the brow and then gradually raise and raise the brow with your finger. So you probably only want to start with 10 of these repetitions because you will be doing exercises for all of your facial muscles.

Frowning:

• Bring your eyebrows together making an angry face.
• For this movement you have to put your finger on the top of your eyebrow and push inwards, just squeezing in about 10 times.

Smiling:

• Stand in front of a mirror, and try to open your mouth in an attempt for showing teeth, followed by closing your mouth. Practice this exercise 10 times per session thus completing two to three sessions per day.

Lips Squeezing:

• Stand in front of a mirror, try to press your lips together gently, hold this lipstick state for 10 seconds, and let them relax, repeat again after a pause.

Tongue Movements:

• Practice moving your tongue out of your mouth and attempting to reach it down to touch your chin. Practice repeatedly until you succeeded to reach your chin.

Eye Movements:

• Stand in front of a mirror, attempt to look down while closing your affected eye, and massage your affected eyelid gently.
• Close your eyes, then try to open your eye alternatively followed by gently squeezing them to close.

Blowing Air:

• Sit comfortably on a chair, and try to hold as much air as you can, in your mouth. Maintain this position for 10 secs followed by gently blowing all the air out of your mouth.
• You can perform 10 repetitions gradually increasing the frequency each day.

Cheek Exercises:

• Sit in a relaxed position on a chair. Try to hold your cheeks between your teeth from inside your mouth.
• Hold the position for 10 secs and repeat again.

Blowing a Balloon:

• This exercise is highly recommended as it is effective for all facial muscles. Take a balloon and hold it between your lips and try to blow the air into the balloon as hard as you can. This is the best exercise for stimulating and strengthening all facial muscles.

Facial Massage:

• Gently rub the weaker side up toward the cheekbones
  Continue to massage this area gently.
• 2-3 minutes session is enough initially, try to practice each exercise 3-5 times a day then gradually increase sets per session.

Other modalities of treatment:

TENS (Transcutanoues electric Nerve stimulator)/EMS:

• This device is used to stimulate muscle by electrical impulses generated by these devices via small pads applied directly to the muscles.
• The phenomenon on which EMS works is alternative contraction and relaxation of the desired muscle, regaining its tone and activity. This device is highly recommended for bell’s palsy.

Deep Heat:

• Deep heat increases blood flow to the affected or paralyzed muscles thus stimulating muscular activity and coordination.

Therapeutic Ultrasound:

• This technique is also useful for patients with bell’s palsy thus increasing muscle flexibility and strength.