Exercise physiotherapy can help weakness from Bell palsy

Woman looking in the mirror

Facial exercises in front of a mirror can help patients with Bell palsy who suffer from persistent weakness.

Exercise physiotherapy is recommended for Bell palsy patients with persistent weakness, according to clinical practice guidelines published in the September 2014 Canadian Medical Association Journal.  A multidisciplinary panel that included Dr. Joseph Chen from Sunnybrook Department of Otolaryngology and myself developed the guidelines.

Bell palsy is a weakness or paralysis of the facial muscles, thought to be due a virus affecting the facial nerve. Most patients will have complete recovery, usually within 3 to 6 months. But about 20 per cent of patients will have persistent weakness. These people report problems with eating, drinking and speaking, as well as with facial expressions such as smiling. The psychological effects are significant.

At the time of onset, patients should seek medical attention to ensure appropriate diagnosis and medical management (like medication and proper eye care). Facial exercises are inappropriate at first, as the facial nerve needs time to heal. Forceful facial movements have little effect other than to exercise the uninvolved side. Later, they may be harmful as they can reinforce improper movement.

If there is persistent facial weakness after 3 to 6 months, an appointment with a facial physiotherapist may be helpful. The physiotherapist evaluates the patient’s recovery and works with the patient to develop an individualized treatment plan. Treatment may include facial muscle relaxation techniques, as well as retraining exercises in front of a mirror. Even patients with longstanding facial weakness may benefit from treatment.

You can read the full guidelines here.

About the author

Joanne Dorion

Joanne Dorian is a physiotherapist.

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