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.
See a physician right away. Bell’s Palsy needs to be diagnosed properly and you need the right medications.
If you also feel some sudden numbness and/or especially weakness in your arm or leg, alongside trouble seeing in both eyes and a loss of balance or concentration, then you need to call 9-1-1 and seek medical attention.
If you decide to meet with your doctor, or head straight to the emergency room, then you are making the right decision. However, if the symptoms are confined solely to your face muscles, then you need to see a physician straight away. In the ER or an office. You could have Bell’s Palsy, and this condition needs to be diagnosed properly for the correct medications and treatment.
Medical studies are unanimous in agreement that people affected by Bell’s Palsy have a better chance of fully recovering, without complication, if they are proactive in seeking necessary medical treatment.
Your facial paralysis needs to be officially diagnosed, and other more sinister afflictions - such as a stroke, Ramsay Hunt Syndrome, Lyme disease, or other types of facial paralysis - need to be ruled out.
I can’t stress the importance of your diagnosis enough. Regardless of what you think might have happened to your wellbeing, or your suspected reason for encountering facial paralysis, you need a professional diagnosis to ensure you start that path to recovery.
Causes for developing Bell’s palsy include exposure to herpes, chickenpox/shingles, mononucleosis, respiratory infections or other viruses, often combined with stress, exposure to cold, and a depressed immune system.
Discovering That You Have Bell’s Palsy
After your diagnosis, once you’ve been told that you have Bell’s Palsy, it’s likely that you will feel adrift due to a lack of information. You’ll have many questions about your condition, but your MD - and even your regular physical therapist - won’t be able to fully explain your condition.
You won’t be told much in regards to why you ended up with this physically limiting, and emotionally draining, syndrome. When you ask about how long your face will be paralyzed, and your chance of recovery, you will likely be told that you should normally recover - but it’s hard to say when.
You’ll be told to start taking the prescribed medications (steroids, antivirals) and return for another visit in 3-6 weeks if symptoms have not improved.
This is how 95% of medical appointments go for patients with freshly-diagnosed Bell’s Palsy. A correct diagnosis and accompanying relevant prescription is absolutely necessary to address inflammation and relieve pressure placed upon your facial muscles and nerves.
This leaves a lot of questions unanswered about what you can expect in your recovery...
I am here to reassure you that your doctor likely told you as much as they can at this point. No one knows, or can predict, how long your facial nerve and muscles will take to heal. Neural tissues are the slowest healing in the human body. The consensus is that nerves heal and “regenerate” at a rate of 1 millimeter per day on average.
For more detail on the anatomy and process involved, please check this other blogpost going into more details as to what the heck is making your facial nerve misbehave.
So, at this point, you likely feel a bit lost, angry, sad, and wonder if you will ever recover and regain your beautiful and normal face functions and features.
If you are lucky, you might get referred to a neurologist or otolaryngologist for further assessment and, if luckier, sent to physical therapy for facial exercises /rehab. Even luckier people are referred to a physical therapist who has real experience in treating Bell’s Palsy. That’s where I can help.
Let’s Talk Facts About Bell’s Palsy!
Bell’s Palsy occurs in about 6 out of 100 people in their lifetime. A total of 71% of people recover fully within twelve months. That’s all great for the 71%, but the other 29% have a longer road ahead, with more complications. They can still possibly recover but it’s not a sure thing.
The problem is that you don’t know, early on, when first diagnosed, what percentage group you will fall in. Will you recover fully or be possibly affected forever? Are you a part of the 71% Club, or the dreaded 29% Club?
Studies show that those who start steroidal treatment within 72 hours of onset symptoms have a significantly increased chance of recovery.
Other studies show that people taking - in addition to steroids - a prescription of antivirals meds also recover with more efficiency. This would make sense from the standpoint of Bell’s Palsy being likely initiated by exposure to a virus.
However, there is a distinct lack of studies that outline the long-term effect and recurrence of Bell’s Palsy. While the common concept remains that people have Bell’s Palsy only once in their life, other individuals can actually suffer from Bell’s Palsy more than once. If you have had Bell’s palsy once, you have 7-15% chance of a recurring episode.
Some unfortunate individuals may be left with long-term effects. Many patients report asymmetry in facial features and motion. These aspects could be minimal enough that most people simply accept them, whereas others consider themselves recovered - despite lingering after effects.
From reading BP related online forums, social media pages, and groups, it would appear that the number of people still dealing with Bell’s Palsy after a year is much higher than the limited research would have you believe.
What you can do on your own… And with some help, to ensure an optimal recovery.
What Can I Do To Help My Bell’s Palsy?
I am often asked about ‘what a person can do on their own to relieve the symptoms of Bell’s Palsy. I would heartily encourage a combination of self facial massage, stretches and exercises, to ensure an optimal recovery. There is definitely a correct way to do all this. Just following a generic facial motion exercises sheet can actually lead to complications.
My approach to life is that most good things happen with work and effort. And recovering from Bell’s Palsy, like other neuro musculoskeletal conditions, certainly follows the same mantra.
1) Push for a referral and consultation with a specialist, such as a physical therapist, an otolaryngologist, or a neurologist.
How long should you wait and do that?
As soon as possible.
Do not let more than 3 weeks pass without any objective changes.
If you are experiencing pain, and especially if that pain persists following the completion of your prescription (and doing what is discussed in the second bullet), contact your doctor to discuss potential needs for an extension to your steroidal treatments or nerve pain medications.
Only a medical doctor can make this decision, and they will take your medical history into consideration when your condition is reviewed. This helps keep you safe. If you are pregnant or diabetic, your ability to use steroids could be limited.
2) Learn to manage and address your symptoms!
-To address pain, facial soreness and stiffness, applying moist heat to your face can be greatly beneficial and relaxing. It will help increase blood flow to your muscles by vasodilation, which can have a soothing effect.
-Gently massaging tender spots for a few minutes, several times a day, is also very productive in decreasing your pain and discomfort.
Massages will greatly reduce the chance of complications. It prevents fibrosis in and around your facial muscles. Fibrosis has been linked, and is most often present, when the complication of synkinesis is present.
Here are some examples of massage that can help you:
-Wearing an eyepatch at night, using preservative free eye-drops, taping specific areas of your face, avoiding lying on your involved side at night and other things will help your symptoms, and also put you a little more in control of the situation.
I invite you to check my other blog post in the Bell’s Palsy category and visit my social media page for tips, or check out the Bell’s Palsy Tutorial.
3) Learn to recruit your facial muscles properly and exercise your face on a daily basis.
This is where, I, a physio, come in. Spending time with a physical/physio therapist could be the most important aspect of your rehab.
It will help with learning the correct way to retrain your facial muscles in isolation, in a slow and controlled fashion, applying specific techniques for your condition to help avoid complications.
This also allows the opportunity for learning how to properly massage a specific part of your face to decrease symptoms, help decrease development of fibrosis, target areas of possible synkinesis that develop early, and inhibit them while encouraging facial muscles isolation versus mass contraction (several muscles contracting at same time).
visit my social media page for tips,
or check out the Bell’s Palsy Tutorial.
Many Bell’s Palsy patients I have worked with have followed very generic instructions when it comes to facial exercises, and the subtlety of individual facial muscle recruitment has been overlooked. This can lead to synkinesis by training incorrect movement patterns and failing to prevent mass contraction.
Bell’s Palsy might seem an insurmountable condition to overcome initially. It is very disconcerting to experience such dramatic facial function changes in such a short time.
Yet, contrary to what many patients are left to believe from the lack of direction, education and knowledge, there is a specific course of action you can - and should - take if you are affected. Be curious, be proactive and inquisitive about your options. You will be glad that you did.
The Bell's Palsy Tutorial
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.