If you have Bell’s palsy, one of the first things you are likely to wonder is whether the movement in your face will come back and whether there is anything you should be doing to help it.
For many people, facial movement gradually improves as the facial nerve recovers, although how quickly this happens varies. Some people notice changes quite early, while for others recovery is slower and may continue over several months. Physiotherapy can be useful for some people, particularly if the weakness is taking longer to improve or the face starts to feel tight or move differently as recovery takes place. It is not something that everyone with Bell’s palsy will need.
What is Bell’s palsy?
Bell’s palsy is a weakness or loss of movement on one side of the face. It happens when the facial nerve is not working normally, which affects the muscles used for facial movement and expression. The symptoms usually develop quite quickly, often over several hours or a few days.
You may notice that:
- one side of your mouth drops
- your smile looks uneven
- you find it difficult to lift one eyebrow
- one eye does not close properly
- food or drink escapes from one side of your mouth
- your speech sounds different
Some people also notice a change in taste, a dry or watering eye, or discomfort around the ear.
What causes Bell’s palsy?
The exact cause of Bell’s palsy is not always known. It is thought that the facial nerve becomes inflamed or swollen, which affects the signals travelling from the nerve to the muscles of the face.
In some cases, this may be linked to a viral infection or the reactivation of a virus that has previously been in the body. However, it is not usually possible to say exactly why an individual person has developed Bell’s palsy.
Facial weakness should be checked by a doctor
Although Bell’s palsy is one cause of facial weakness, it is important not to assume that this is what is happening when the symptoms first appear. Sudden facial weakness can also be a sign of a stroke.
If the facial drop happens with arm weakness or difficulty speaking, call 999. These are some of the main signs of a stroke and need immediate medical attention.
If you develop new facial weakness without these other symptoms, you should still seek urgent medical advice through your GP or NHS 111. The NHS advises getting help as soon as possible because treatment for Bell’s palsy is more effective when started within 72 hours of the symptoms beginning.
How can Bell’s palsy affect day to day life?
The muscles of the face are involved in many things we do without thinking about them. Bell’s palsy can therefore affect more than the way your face looks.
Blinking and closing your eye
If the muscles around the eye are weak, you may not be able to blink or close the eye fully. This matters because blinking helps keep the surface of the eye moist and protected.
If your eye does not close properly, you may be advised to use eye drops, ointment or other eye protection while the nerve recovers.
Eating and drinking
Weakness around the lips and cheek can make eating and drinking more awkward. Food may collect between the cheek and teeth, or you may find that drinks escape from the weaker side of your mouth.
For many people, this improves as facial movement starts to return. If eating or drinking becomes particularly difficult, it is worth discussing this with a healthcare professional.
Speaking
The lips and facial muscles help us form certain sounds, so weakness on one side of the face can sometimes make speech sound or feel different. How much this affects someone varies and may change as facial movement returns.
Facial expression and confidence
Facial expression is a big part of how we communicate with other people. If smiling, laughing or other expressions look different from normal, some people understandably become more self conscious, particularly at work or in social situations.
It is worth mentioning this if it is bothering you. Bell’s palsy can affect emotional wellbeing as well as facial movement, and this part of recovery should not be overlooked.
Will the facial weakness improve?
For many people, it does. The NHS advises that Bell’s palsy symptoms should generally improve within six months, although some people recover sooner and others take longer. It is difficult to predict exactly how quickly or how completely an individual person will recover.
Movement may gradually return without any further problems. In some people, however, weakness or tightness can continue, or movements may not return in quite the same way as before.
Sometimes one facial movement starts to cause another movement at the same time. For example, the eye may partly close when you smile. This is known as synkinesis and is one reason why rehabilitation is not simply about trying to make the facial muscles work harder.
Can physiotherapy help Bell’s palsy?
Physiotherapy may help some people with Bell’s palsy, but it depends on what is happening with the facial movement and where you are in your recovery.
In the early stages, the priorities are medical assessment, appropriate medical treatment and protecting the eye if it does not close properly. If weakness continues or movement starts to return but feels tight or difficult to control, a physiotherapist with appropriate experience in facial rehabilitation may assess how different parts of the face are moving and whether there are any unwanted movements.
Not everyone with Bell’s palsy will need physiotherapy, and treatment should be based on what is found during an individual assessment.
What might facial physiotherapy involve?
There is no set treatment that is suitable for everyone with Bell’s palsy. What we do would depend on how much movement has returned, whether there is any tightness and how well the different parts of the face are moving together.
Physiotherapy may include gentle facial movements, stretching, relaxation or massage and electrical stimulation where appropriate. You may also be shown how to practise certain movements slowly and with more control.
If you have started to develop tightness or movements that happen when you do not intend them to, the focus may be more on improving control and coordination. It is not about making the facial muscles work as hard as possible or forcing movement to return.
Should I keep exercising the weak side?
Not necessarily. It is understandable to think that exercising the face more often or making the movements bigger will help the muscles become stronger, but facial rehabilitation does not work in quite the same way as strengthening an arm or a leg.
Exercises, where they are appropriate, are usually chosen according to the stage of recovery and how the face is moving. Generic strengthening exercises may not be suitable, particularly if unwanted movements or tightness have developed. This is also why it is worth being careful about following facial exercise videos online without knowing whether they are suitable for you.
What should I do about my eye?
If Bell’s palsy means you cannot close your eye properly, protecting the eye is important because the surface can become dry or irritated when you are not blinking normally. Your GP, pharmacist, optometrist or eye specialist can advise you about eye drops, ointment or other protection that may be appropriate.
If your eye becomes painful or very red, or you notice a change in your vision, seek medical advice.
What if eating or speaking is still difficult?
Mild problems with eating, drinking or speaking may improve as facial movement returns. If these difficulties continue or are having a significant effect on you, further assessment may be useful.
Depending on the problem, another healthcare professional such as a speech and language therapist may need to be involved as well as, or instead of, physiotherapy. The important point is that the support should be based on what you are actually finding difficult rather than assuming physiotherapy is always the answer.
When should I seek further medical advice?
The NHS advises going back to your GP if your Bell’s palsy symptoms have not started to improve after three weeks. You should also seek further advice if the weakness is getting worse, new symptoms develop, you are struggling to protect your eye, or eating and drinking are becoming difficult.
Recovery can take time, so slower progress does not necessarily mean that no further improvement will happen. However, if something about your recovery concerns you, it is reasonable to have it reviewed.
FAQs
Can Bell’s palsy get better without physiotherapy?
Yes. Many people with Bell’s palsy recover without needing physiotherapy. Physiotherapy may be considered if facial weakness continues or movement becomes tight, uneven or difficult to control.
How long does Bell’s palsy take to improve?
Bell’s palsy commonly improves over several months. The NHS advises that symptoms should generally get better within six months, although recovery can take longer for some people.
When should I start facial exercises?
There is no single time that is right for everyone. Whether exercises are appropriate depends on the stage of recovery and how your face is moving, so it is better to use exercises that have been chosen for your particular situation rather than a generic programme.
Should I massage my face if I have Bell’s palsy?
Massage may form part of facial rehabilitation for some people, particularly where muscles have become tight. It is not automatically necessary or suitable for everyone with Bell’s palsy.
Is facial weakness always Bell’s palsy?
No. Bell’s palsy is one possible cause of facial weakness, which is why new facial weakness needs medical assessment rather than being diagnosed yourself.
When is facial weakness an emergency?
Call 999 if sudden facial weakness occurs with arm weakness or difficulty speaking, as these can be signs of a stroke.
Is Bell’s palsy the same as a stroke?
No. Bell’s palsy affects the facial nerve and is not the same as a stroke. However, both can cause facial weakness, so new or sudden facial drooping should not simply be assumed to be Bell’s palsy. If there is also arm weakness or difficulty speaking, call 999.
What if I am considering physiotherapy?
If you have already been medically assessed and facial weakness is continuing, you may be wondering whether physiotherapy is worth considering. This will depend on how your face is recovering and what difficulties you are having.
We see patients at our physiotherapy clinics in Ashford, Folkestone, Hythe and New Romney. If you contact us about facial weakness following Bell’s palsy, we can discuss what has happened so far and whether physiotherapy assessment with an appropriately experienced physiotherapist may be suitable. If you need a more specialist facial palsy service, we can also let you know if we feel that would be more appropriate.
Phone: 01303 487200
Email: enquiries@physiosrus.co.uk
Contact form: https://www.physiosrus.co.uk/contact-us/
Clinics: Ashford, Folkestone, Hythe and New Romney
Disclaimer
This article provides general information about Bell’s palsy and physiotherapy and does not replace individual medical advice, diagnosis or treatment. New facial weakness should be medically assessed. If you think you or someone else may be having a stroke, call 999.
