Treating acute facial paralysis, either from Bell's palsy, Ramsay Hunt Syndrome, Zoster Sine Herpete, Lyme disease or a facial nerve injury is a slow and complicated process that requires expertise from a therapist, a facial specialist therapist.
See, over 98% of physiotherapists worldwide never learn nor even once treat a facial paralysis patient in their career.
It can be quite rare for a patient to be referred by a physician to physiotherapy for the rehabilitation of facial paralysis. The subtleties of the treatment require a trained eye, that knows the anatomy of the facial musculature, that knows the difference between facial muscles and common muscles in the rest of the bodies ( hint: they behave very different, and so they require a very different treatment approach).
If you are struggling with recovering from facial paralysis, it could be due to many reasons. Muscle tightness and formation of fibrosis in the soft tissue of the face result from the lack of active muscles contraction and activity. It is in my opinion an original reason for the complications that affect a significant amount of facial paralysis patients down the road when recovery from Bell's palsy is not full ( which is a high number in my opinion, 29%).
Today we will look at one mu0scle of the face in particular that is extremely important to maintain normal facial symmetry (particularly as the face regain movement), normal mouth opening, regaining a normal smile and preventing synkinesis between the eye and mouth. That little devil is called the Buccinator.
First, a few facts about synkinesis.
It is the third stage of Bell’s palsy, which most of you will never, thankfully, experience.
It is a complication of facial paralysis that develop from a combination of tightness, nerve injury and abnormal facial movement patterns.
It is a very complex condition to rehabilitate, is slow and recovery will require patience and dedication from the patient.
Frustration and distress tends to be a mainstay of patients with synkinesis.
As a facial specialist physical therapist, my first advice is to not go at it on your own. It is hard enough to treat with supports from a team of professionals. Always consult with a professional to manage your synkinesis.
Restoration of soft tissue mobility and flexibility, relaxation, neuromuscular reeducation, education are all needed and sometimes chemo-denervation, more often known as botox injections, and surgery can be necessary.
It takes a good understanding of the anatomy of the facial muscles and knowing what movement these muscles do to have a chance at improving.
When practicing facial movement, it should be slow, gentle, controlled, subtle, graceful. It requires knowing where the muscles “address” is, which directions each muscles contraction pull the skin towards, what "tug-o-war" is happening that is preventing normal movement.
Synkinesis is NOT due to weakness of facial muscles. It is due to incorrect muscles activation for a specific facial movement, lack of coordination for that same movement, lack of soft tissue mobility, tightness of specific muscles, overworking of the involved sides( too many muscles firing at same time). Normal facial movement will not come back without proper retraining.
The good news is that improvement can happened even long after the nerve has healed. So it is never too late to address your synkinesis. But of course, the earlier in the process you start working on it, the highest chance for a more prompt recovery. And of course, the goal being to never reach the synkinesis stage by massaging and stretching and avoiding gross mass facial contraction.
During the synkinesis stage, your nerve is working! Otherwise, you would not see that overactivity nor tightness.
Treating synkinesis does not require, contrary to many’s belief, strengthening the muscles, forcing movement.
One of the reason why synkinesis happens only in the face is that only in the face are a muscle performing one movement and its antagonist( muscles performing the opposite movement) innervated by the same nerve, the facial nerve.
If you take your arm for example, your biceps which flex your elbow, is innervated by the musculocutaneous nerve while its antagonist, the triceps is innervated by the radial nerve and so one nerve injury does not prevent the antagonist from working…which is not the case here in the face.
When you look at a diagram of the face, you can see the different muscles, all pulling in a specific direction. The balance of relaxation and pulling has to be coordinated in order to produce the correct movement.
To restore soft tissue mobility, massage, trigger point release, use of heat and stretching are the hallmark.
Stretching is the bulk of the treatment I start with patient coming to see me for synkinesis.
Stretching and releasing the right muscles will help the face relax and make facial movement less forceful and more natural.
Just from stretching , I see my patient make improvement and their synkinesis can sometimes decrease in one treatment.
The key is knowing which stretch(es) to work on. Hence working with a facial specialist.
You want to stretch in the opposite direction that tight muscles is pulling. This is why you need to know what way is that muscles pulling. and this can be difficult for a non trained individual.
To release muscles, Let’s review this again.
Always start by comparing each side. How does your left vs your right feels? I would try to give a grade to that tightness and write it down, document it…which is a great way to monitor progress.
The areas of your face that feels the most different ( highest difference in tightness grade) are the area you want to focus on.
It is about letting the muscles melt, using the analogy of the ice cube melting between two fingers ( your thumb and index).
Apply gentle pressure between 2 fingers, make sure it is pain free and hold for a minutes.
Here are common spot for trigger point.
Make sure to perform these frequently when you first start treating your synkinesis: I advise my patient to perform, if possible, every couple hours.
Relaxation is important for treating synkinesis.
Here is a link to an audio self guided facial relaxation session.
It is free:.
The next part of treating synkinesis is neuromuscular reeducation.
That part of treatment is the most difficult and it is unique to each patient. You need one on one help for this as there is not one technique that will work for everyone.
Working with a specialist, you wil be taught how to analyze a particular facial motion: compare it to the non affected side and use that sounds side as a model for the movement pattern to relearn. Learning what other muscles movement are “in the way” and blocking that movement from happening correctly and then suppressing that movement to prevent pull in the wrong directions...
Learning to feel your face instead of using visual cueing and seeing it will be helpful in this retraining as well.
Botox injection can be a good adjunct to what we just discussed.
Botulinum toxin works by decreasing the activity of overactive muscles to a more normal level. The person you are receiving the injections from must be trained in facial palsy and be a facial specialist.
These injections can allow better relearning of correct and more precise facial movements during the time the antagonist are quieter from the botox.
These injections, depending on the presentation of the patient, can be either in the non involved or involved side.
Many type of surgeries, done by a facial surgeon that specialize in facial palsy, could be performed depending on the presentation and response to previous treatment.
It is beyond the scope of this article.
I want to reiterate that treating Synkinesis is a slow complicated process.
Just like any other nerve injury, you cannot expect being cured overnight. Think of a spinal cord injury or a stroke...
No quick fix exist and lots of work from the patient, with the support of a facial specialist, needs to be put in. Dedication, focus and concentration are needed but patience will pay off.
Help is available:
The Bell's Palsy Online Tutorial
Schedule Your Online Consultation With A Facial Specialist
Smiling is essential to life... To communicate happiness, demonstrate agreement, satisfaction and that what we are hearing or seeing is funny or pleasant.
Could you imagine a world where no one can or is able to smile?
Smiling is essential...
This can become more of a reality when once is affected by Bell's Palsy and most would do anything to see their lips pull up and out.
Working directly with Bell's palsy sufferers for many years, I know firsthand that regaining the ability to smile is for most a priority. There is a connection between our emotional well beings, our social lives and the ability to smile. For many, not being able to smile is downright depressing and affects them psychologically, bringing on more stress.
So, how does one retrain their face to smile again? What exercises or hands-on technique one can use, at home, to improve and regain their smile, and what should you pay attention to and not overlook?
Last month, I had the pleasure to have a conversation about Bell's Palsy with Dave Candy, DPT, OCS, ATC, FAAOMPT of More 4 Life, a physic therapist in St Louis specializing in chronic pain. I was featured on his podcast, the St Louis Pain Expert Podcast.
The episode is entitled Start Smiling Again-Overcoming Bell's Palsy with Pierre Butheau.
I go over explaining Bell's palsy, how you can recognize it, the importance of seeking out treatment, how facial muscles differs from other musculoskeletal muscles, and retraining facial muscles in a very specific way, and treatments available.
Here it is:
Pierre Butheau was featured on the St. Louis Pain Expert Podcast.
Click the play button to listen now...
On this episode, Dr. Dave Candy and special guest Pierre Butheau discuss tips & advice on seeking treatment for people who suffer from Bell's Palsy.
Need Help For Bell's Palsy?
You can also listen to it of Dr. Candy's podcast website, St Louis Pain Expert Podcast.
The episode is available on Apple Podcast:
And on his website directly:
You wake up one day and feel different. But not in a god way.
You notice that it’s not possible to blink or to close your eye. Maybe you notice a droop on one side of your face.
Perhaps you discover something is wrong when you take your first sip of morning coffee, only to drool and remain unable to seal your lips around your cup.
Just diagnosed with Bell's palsy? Here is the first thing you should know. The good thing? It is not a death sentence. No matter how bad you feel or it looks right now.
Top Bell's Palsy Fact Answered: Can You Get It More Than Once? What Are The Priorities? How To Massage My Forehead? Ramsay-Hunt Syndrome & Antivirals, How To Massage My Chin?
‼️This post is for informational and educational purpose only. It is not tailored medical advice to your specific condition.
Top Bell's Palsy Fact Answered: Stretching Around The Eye, Why Do Muscles Of Face Heal At A Different Rate, Mirror Mirror...Say What?, No Wait & See Approach
This post is for informational and educational purpose only. It is not tailored medical advice to your specific condition.
Techniques to stretch muscles surrounding the eye
Top Bell's Palsy Fact Answered: Telehealth, Vitamin B12, Right Way To Exercise Your Face, & How Do You Measure Progress?
This post is for informational and educational purpose only. It is not tailored medical advice to your specific condition.
What If there was an easier way to get treated for your Bell's palsy
Let’s face it, many people are reluctant to go in medical offices these days. The Coronavirus pandemic has created an atmosphere where there are risks every time we are surrounded with other people indoor.
Even though it does not offer hands-on treatment like a in-person office visit would, Telehealth consultations and treatments have become more popular.
Telehealth treatments can be very beneficial for treating Bell’s Palsy. Because of the face to face set-up with camera, it allows the practitioner to assess facial expression, movement, asymmetry, muscular activity by following a standardized assessment and using a scale to grade facial muscular activity.
Telehealth allows close and thorough patient education by teaching facial neuromuscular reeducation and motor control using appropriate techniques, tips and cueing versus just following a generic video on YouTube that might not be tailored to your specific needs.
Top Bell's Palsy Fact Answered: Chance of Recovery, Ramsay Hunt Syndrome, Eye Closing With Bell's Palsy, & Face massage
You may or may not know that you do early in your Bell’s Palsy recovery greatly affect your progress.
For 29% of people, turns out that that it is key in their recovery, being part of the group that will not just recover on its own.
The problem is that when you have Bell’s palsy, you have no way of knowing which group you belong to.
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And It Does Not Work!
Most people that suffer from Bell’s Palsy will read about or hear about electrical stimulation for treatment of BP
The chance is that they will think of a TENS unit as viable in treating facial paralysis... And IT IS NOT.
TENS unit is for treatment of pain only, NOT to activate and strengthen muscles
The user manuals clearly say to never apply on the face ( that should be your first clue )
The size of the electrode, as with 95% of other type of electrical stimulation units, is not appropriate as it would stimulate too many muscles at once>>>> hence the risk of developing synkinesis since you would be contracting several muscles at once instead of one.
So, all in all, TENS is not a modality that has any benefits in treating BP. And possibly negative effects in reality.
DO NOT USE TENS UNIT TO TREAT BELL’S PALSY!
Top Bell's Palsy Fact Answered: Which Medical Professional To See, When Can I Start To Exercise? Work?, Does Acupuncture Help?, What Makes Bell's Palsy Recovery Worse?
What healthcare professionals can help me when I am dealing with Bell’s Palsy?
First and foremost, you should be evaluated by a physician. Most people will see their primary care physician/family doctor, or an Emergency or urgent care department physician. The goal here should be for a correct Bell’s Palsy diagnosis and prescription of steroids and antivirals.
Consulting with a facial specialist within the first 3 weeks after onset, especially if there are no signs of improvement, should be the next step. You can consult with:
An Otolaryngologist, or ENT( for ear, nose and throat doctor).
An Opthalmologist, especially if your eye is involved, you cannot blink, your eyes is irritated, itchy, red and painful. If your condition goes on for too long, an oculopastic surgeon ophtalmologist should be helpul
Neurologist: there exist many different type of neurologist and subspecialty and of course, I would recommend one with extra facial paralysis and conditions training
Physical / Physio Therapist ( that’s me , ).
I would be particularly picky in finding a PT with experience and training in treating Bell’s Palsy. A normal university PT curriculum does not teach facial muscles rehab to their student. Just ask when you contact them.
If you failed to progress after several months and still suffer with severe paralysis, consulting with a facial plastic surgeon would be helpful as they can help with recovery of facial movements and expressions
Top Bell's Palsy Fact Answered: How Long To Recover? Incidence Of Bell's Palsy In The USA, Lagophthalmos.
You are unsure what is causing this and become concerned.
You see a doctor shortly after who after assessing you, prescribes you with corticosteroids and an antiviral to treat the diagnosis of Bell’s Palsy.
As a healthcare provider that has worked and helped Bell's palsy patients for the past 18 years, I can't say I am surprised anymore when a patient or prospective patient mentions they feel lost, alone... Feel like they have not been given much guidance besides, and even not always, been prescribed steroids and antivirals....
They mention how they don't know what they should be doing to work on improving their condition. Should they take vitamin? Should they have massage? Should they use electrical stimulation? Should they continue exercise? Can they continue jogging? Should they just rest, and lie down for the next months crossing their fingers their face will start moving again?
I would like to talk to you about the saphenous nerve. Why am I talking about that today? The saphenous nerve could be the source of pain in your knee or anywhere down your leg, all the way down to your foot for various reason.
This nerve is a continuation of your femoral nerve. Your femoral nerve comes from your lower back... from your spinal cord, into your lower back and around your thigh. It gives into several branches. One of these branch is the saphenous nerve.
One thing to understand is that the saphenous nerve is a sensory nerve and it does not innervate any muscles.
If you sustained an injury to this nerve, you will not see really any particular weakness from that injury. Even without weakness, that could be the source of quite a bit of pain that could arise anywhere along the distribution of that nerve.
WHY WEARING MINIMALIST SHOES COULD HELP YOU MOVE BETTER AND RELIEVE FOOT, ANKLE, KNEE, HIP AND BACK PAIN
You might have heard of them... Or seen more and more people wearing them...Or maybe had a glimpse at them at your favorite shoe retailer. Shoes that look quite different than what you’d consider traditional…they look wider, look shorter, with a very small sole that looks like the manufacturers saved on using material…
Could these really be comfortable and how would it feel to walk in them?
You might be skeptical has you have had foot problems all your life, been told to wear extra insoles with an increased arch, or have seen countless foot doctors that recommended you do so…
In this post I would like to discuss what has been dubbed minimalist shoes, how they could allow a more natural way to move , and how they could help you with aches and pain.
So just a few days ago we looked at how to descend stairs when you have new pain/when going down steps reproduces the pain.
Today, I would like to show you how to properly go up a step, what you can do, how to place your feet and how to optimize the right muscle use to prevent strain on your knee and prevent pain.
What is important to remember with climbing stairs is that most of us are actually climbing stairs the wrong way, or at least not the most optimal way.
So today I would like to start a serie on knee pain. I will approach several common reasons for having knee pain with common movements and tasks. I will also demonstrate what you can do about it and what you can change with specific exercises that will help you correct what you are doing wrong.
We have many patients that come to see us with complaints of knee pain stating that they have had increasing difficulty with knee pain when they ascend or descend stairs, going over curbs or stepping off a high platform, and even walking or hiking on hills.
Using stairs is a required and normal part of life to participate in society but it is far from easy for many.
A lot of people that have knee pain think or have the conception that the problem is coming from inside the knee joint, that a structure is likely injured or not doing what it is supposed to do. I am here to tell you that it is rarely the case. I think that the knee joint generally deteriorates only from direct trauma, or much more often from problem occurring at the hip and ankle joints instead.
So today I would like to talk to you about a question that I often see on forums online or I have been ask by patients is...
Is physical therapy or physiotherapy appropriate after a car accident?
My answer today's is 100%, Yes!
Bell's Palsy is considered a rare condition but it still affects over 40,000 Americans between the age of 16 and 60.
A lot of the research and best course action to treat it remain a source of debate and disagreement.
It is a neuromuskuloskeletal condition since it affects both the facial nerve and muscles of the face it innervates.
I may be be biased, but as a physical therapist (physio for anyone living outside of the USA), and as a fully recovered Bell's palsy patient myself, I believe it is my duty to educate the population with what physical therapy can do when suffering from this rapid, debilitating, physically and socially, condition.
It's February... We are right in the thick of winter. If you exercises outdoor, winter might not be a time you particularly relish. You might even have switch all of your workouts indoor by now. Or worse... You might have stopped exercising altogether because you have been less than motivated and feeling lethargic from the weather...
Curling up under a blanket by a fireplace likely sounds more appealing.
But know that winter tends to bring a weight gain of 5 to 10 pounds on average. Can you only blame the weather?
Winter is of course a great time for outdoor activities and cardiovascular activities.
Today, my only goal is to do a review of the risks, but mostly the benefits of exercising in cold weather.
You might have to take extra precautions and measures but will learn that winter brings on special benefits when it comes to exercising.
Hello followers. So today I would like to discuss a tip for aneck pain. This is also a self test to see if you would benefit from this motion. This particular motion I will demonstrate is called retraction, as well as retraction in combination with side bending. And very often, and I see this with most of my patients and most people that have neck pain is, that motion is being lost over the years. And there's a good reason for that and that is because we really don't do any activities with that particular position of our head and neck. And so I won't, take too much of your time. I will just demonstrate. So the motion I'm talking about is retraction. Retraction is this motion. So not this.... but bringing your chin straight back, just kind of like a turtle.
So what I see is, with my patients... a lot of patients are positioned in this position for too long and they basically can't... they have very, limited emotion in this direction. So one thing that you can do to make this a little bit easier would be to kind of squeeze your shoulder blades a little bit and then bringing your chin back and make sure that you spend less and less amount of time during the day where you're in this position, which can really limit, your mobility over the years of being able to do this. These can create a lot of compression on joints and nerves in your neck and leads to a bunch of problems in the neck as well as the shoulder. So this motion that is called retraction. So if you have neck pain, my suggestion would be to do in case it's about 10 times an hour. So that won't take very long, but that is a good mobility.
The other one would be side bending in combination with retraction. So you would start in the same way... back like this, and then add this motion. So with a lot of my patient, I see a mobility that's just about this way. And then that's it. And that's all they have. And you really want to strive to.... to maintain that mobility as much as you can and both ways.
So that's it for today. Give that a try ..., leave me comments and let me know if that is helping your neck ...
I'll catch you later. Bye
15034 5th Ln S
Burien, WA 98148
If you're watching these video is maybe because you have Tennis Elbow otherwise known as lateral epicondylitis... or maybe you know someone that suffers from it. It is fairly common and today I 'd like to show you some exercises and gentle mobilization I give my patients to work on at home in order to treat themself.
So the first thing involved with lateral epicondylitis is generally some tension in the radial nerve. I would like to show you is how to mobilize your radial nerve. In standing like this, the first thing I do is on the involved side, which let's say my right elbow is involved. Turning your arm in, lifting your pinky up and bringing your arm out in a little bit back and immediately returning. You're going to stay within the range of motion and where you feel the pull in your arm. Not trying to go too much into the pain if it's painful at the end of the range. And basically just oscillating like this for 30 seconds.
In this post, I’d like to offer a step-by-step guide to addressing your sciatica, no matter if it has been going on for 3 days or 3 years. My goal is to at least give you a proactive head start and empower you with at least a little knowledge on what you should be actively doing now, even if you are scheduled to work with a physical therapist or another health practitioner in the very near future.
The following tips and instructions should help with at least some of your symptoms, if not all.
I will not go into details as the possible cause and symptoms of why you might be experiencing. For this I will redirect you to a previous post I wrote in 2017, 3 Common Causes & Symptoms of Back Pain & Sciatica.
You can also check more on the definition of sciatica and things to consider in this free E-book on Sciatica:
Pierre-Yves Butheau, MPT, CMP has been a physiotherapist for 19 years and has a passion for helping people move better, return from and prevent injuries, as well as improve their function and quality of life. He has a strong interest in addressing the root cause of and treating neuro-musculoskeletal conditions while educating his patients with the knowledge to manage their conditions and prevent recurrence. Pierre also has a niche in treating Bell's palsy and temporomandibular joint dysfunctions.