Bell’s palsy is a condition characterized by the sudden weakening or paralysis of facial muscles, which is temporary for most people. The experience can be unsettling, but for most, facial strength and expression return within a few weeks to six months. A structured approach to facial exercises can support this healing process, helping to improve muscle strength and coordination.
When to Begin Facial Exercises
The initial step in managing Bell’s palsy is to seek advice from a healthcare provider or physical therapist. They can confirm the diagnosis, rule out other conditions, and create a personalized treatment plan. During the first week after symptoms appear, the facial nerve is often significantly inflamed. Forcing movements during this acute phase can be counterproductive, so a period of rest is recommended to allow the inflammation to subside.
Starting exercises prematurely may strain the already compromised nerve and facial muscles. A physical therapist can determine the appropriate time to begin, which is after the initial, most severe symptoms have stabilized. This professional guidance ensures that exercises are introduced when they can be most beneficial.
Gentle Facial Massage and Stretching
Before progressing to active exercises, gentle massage prepares the facial muscles. This technique helps to improve blood circulation, maintain muscle flexibility, and provide sensory stimulation to the affected side of the face. The National Institute of Neurological Disorders and Stroke (NINDS) recommends massage as a beneficial treatment for Bell’s Palsy.
Using your fingertips, you can perform slow, careful movements on the affected areas. On the forehead, massage upward from the eyebrow to the hairline. For the cheek area, use gentle circular motions with your fingertips. Around the mouth, you can use your thumb and index finger to gently push the corner of the lip toward the center of the face into a pucker, and then ease it back. These actions should be performed gently and without causing pain.
Specific Facial Muscle Exercises
Once cleared by a professional, specific exercises can help re-educate and strengthen the facial muscles. It is helpful to perform these movements slowly in front of a mirror to monitor your form and ensure only the targeted muscles are working. The focus should be on the quality of the movement, not the quantity of repetitions or the force applied.
Practice the following exercises for different facial regions:
- Raise your eyebrows, using your fingers to gently assist the affected side.
- Gently close the eye on the affected side, and alternate between opening your eyes wide and then squeezing them shut.
- Wrinkle your nose, using your fingers to gently push up the skin next to your nose if needed.
- Puff out your cheeks and then blow the air out.
- Practice smiling by drawing the corners of your mouth outward, using your fingers for assistance on the weak side.
- Gently pucker your lips and then relax them to improve control.
Managing Complications During Recovery
During the recovery process, a complication called synkinesis can sometimes develop. Synkinesis is characterized by unintentional, linked movements, such as the eye automatically closing when you attempt to smile or the cheek lifting when you close your eye. This occurs due to the facial nerve fibers reconnecting to the wrong muscle groups as they regenerate. At this stage, the goal of therapy shifts from general strengthening to re-coordinating and isolating muscle movements.
To manage synkinesis, the focus turns to performing very slow, deliberate movements while trying to prevent the unwanted associated action. For instance, you might practice a very small, slow smile in the mirror while consciously working to keep the eye on the affected side open and relaxed. Relaxation techniques and gentle massage of both sides of the face can also be beneficial. Working with a therapist is important if synkinesis develops, as they can provide a tailored program.