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Physical Therapy For Bell’s palsy

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.

Bell’s palsy being an injury to the facial nerve, leading to its inflammation and the resulting paralysis of the face muscles, it would make sense that working on regaining control and movement of these muscles would help the recovery… Especially in the presence of a nerve injury, which is the type of body tissue that heals the slowest. 

Well, although it can sound obvious that Bell’s Palsy patients should be either referred to a competent physical therapist with experience in treating Bell’s palsy, or attempt to work with one, it actually is not.   As a PT, our services to help Bell’s palsy patients, especially acutely, when they have just been diagnosed, have been seriously under utilized.  Mostly from lack of knowledge or understanding about what we do.  Physios are movement specialists, with academic backgrounds in exercise sciences, biomechanics, neurology, orthopedic and cardiovascular system.  There is no other profession better suited to actively treat a neuromusculoskeletal injury.

And I have seen first end the effect in the speed of  Bell’s palsy recovery with patients that had PT treatment early on vs late in their rehab.

Too often, our services to help Bell’s palsy sufferers, if considered,  are considered late in the disease process…Often with more difficult cases…after several weeks or months of lack of progress. which is never a good signs for neurological conditions.

I am always amazed about what I read on Bell’s palsy support groups online, where does not seem to be a good consensus in the treatment. I read about too many people that either have been sent home from an emergency department without medications being told they will recover on their own, or  have to ask for PT treatment to their doctors after reading it helped other people, or are being referred when everything else has failed…and by then the patient is in major distress because of the emotional and social impact these disease has on the patient.

There exists many studies demonstrating either good support for the place physical therapy has in the management of Bell’s palsy or inconclusive studies showing no significant effects. Same thing for the use of electrical stimulation in the rehab process… Some swear by it and others just plain vilify it. Even though there exists legions of type of electrical stimulation varying on the type of current use, the application protocol, the electrode use and locations.   One reason for the vilifications of E-stim in the treatment of Bell’s palsy is the possible complication called synkinesis which has been observed in some patients after use of E-stim.

Synkinesis means “simultaneous movement.” Synkinesis occurs secondary to abnormal facial nerve regeneration after Bell’s palsy, or in instances where the facial nerve has been cut, like after trauma and sewn back together. The facial nerve fibers can implant into the different muscles in cases of Bell’s palsy.


Synkinesis, therefore, results in abnormal synchronization of facial movement where muscles, other than those intended, contract together during a particular movement pattern. Exemple of synkinesis: voluntary eye contraction such as blinking or brow lifting elicits an involuntary mouth movement, such as smiling, puckering, closing.

​Although I don’t deny the existence of synkinesis, which is the worst chronic symptoms of unrecovered Bell’s 

palsy cases, I want to make a point that synkinesis will generally occur when retraining several facial motion at once, like with most electrical stimulation units as the electrodes are too big generally and cover too many muscles at once.  
It is of the utmost importance if you are going to use electrical stimulation in the treatment of Bell’s Palsy that you use a type of E-stim that will allow only specific stimulation to one muscle…instead of using one that will create mass stimulation of half the face.  And I am only familiar with one type of E-stim that can specifically target one muscles.
My advice for anyone considering to work with a physical therapist to treat their Bell’s palsy is asked prior to treatment if they are familiar with the face muscles, synkinesis and the Port Muscle Stim- EMS-1C And Pulsed Current.

Having solved my Bell’s palsy in ten days and my patients healing 100% between 2 to 5 weeks, using a mix of massage, instrument assisted soft tissue mobilization,  facial muscle stretching, 

strengthening and E-stim ( yes the correct one), I decided it was my duty to create a step by step guide to Bell’s palsy treatment.

After months of planning, writing, filming, video editing and online launching, I was able to create the The Bell’s palsy Tutorial: The Step-By-Step Online Guide To Recovery



My goal is to help as many people heal from Bell’s Palsy by empowering them with the appropriate knowledge of what they should be doing at home( or with the help of a physio) after they have been diagnosed with Bell’s Palsy by their physicians… in addition to compliance with their physicians recommended prescription.

I am proud to launch 

 The Bell’s palsy Tutorial: The Step-By-Step Online Guide To Recovery this week. It will be available on my website no matter where you live in the world.  It is over 90 minutes long with video chapters, illustrations, and treatment demonstrations, covering all aspect of the recovery. Click on the link below to see previews and a list of topics and questions I cover in it.

Don’t hesitate to contact me with your questions: pierre@butheauphysio.com
Butheau Physiotherapy
​15034 5th Ln S
Burien, WA 98148

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