There are several causes of facial paralysis, such as tumors of the facial nerve or tumors of the base of the brain, trauma, or a congenital condition (a condition that you’re born with). Bell palsy usually begins with a sudden weakness on one side of your face or a sudden feeling that you can’t move one side of your face. It’s important for you to know that these can be symptoms of such conditions as stroke. Seek medical care immediately, especially if your facial weakness is accompanied by:

What Is Bell Palsy?

Bell palsy is a form of temporary facial paralysis. It occurs when the nerve that controls movement on one side of your face becomes inflamed. The condition often comes on suddenly but improves on its own within a few weeks. Although the cause of Bell palsy remains unclear, it’s thought that some cases might be caused by the herpes virus that also causes cold sores.

Signs and Symptoms

Bell palsy usually begins with a sudden weakness on one side of your face or a sudden feeling that you can’t move one side of your face. The weakness gets worse quickly. Other symptoms include:

How Can a Physical Therapist Help?

In the first couple of days to a week after symptoms start, your physical therapist will evaluate your condition, including:

Your physical therapist will immediately:

The first priority is to protect your eye. The inability to completely and quickly close your eye makes the eye vulnerable to injury from dryness and debris. Debris can scratch the cornea—the transparent front part of the eye that covers the iris, pupil, and front chamber of the eye—and could permanently harm your vision. Your physical therapist will immediately show you how to protect your eye, such as:

If you have partial facial movement, your therapist will teach you a few general facial exercises to do at home. These exercises will help you learn to move the weak side of your face and help you use both sides of your face together. One of the exercises is a gentle blowing action through your lips.

During Recovery

Your physical therapist will help you regain the healthy pattern of movements that you need for facial expressions and function. Recovery can be challenging because:

Your physical therapist will be your coach throughout this challenging time, guiding you through special exercises that are designed to help you relearn facial movements based on your particular movement problems. Your exercises may change over the course of recovery:

“Initiation” exercises. In the early stages, when you might have difficulty producing any facial movement at all, your therapist will teach you exercises that cause (“initiate”) facial movement. Your therapist will show you how to position your face to make it easier to move (called “assisted range of motion”) or how to “trigger” the facial muscles to do what you want them to do.

“Facilitation” exercises. Once you’re able to initiate movement of the facial muscles, your therapist will design exercises to increase the activity of the muscles, strengthen the muscles, and improve your ability to use the muscles for longer periods of time (“facilitate” muscle activity).

Movement control exercises. Your therapist will design exercises to:

To work on coordinating your facial muscles, you’ll need to have a sufficient level of activation of facial muscles first. Your therapist will determine when you’re ready.

Relaxation.During recovery, you might have facial spasms or twitches. Your physical therapist will design exercises to reduce this unwanted muscle activity. The therapist will teach you how to recognize when you are activating the facial muscle and when the muscle is at rest. By learning to contract the facial muscle forcefully and then stop, you will be able to relax your facial muscles at will and decrease twitches and spasms.

After Recovery

Some people might have greater difficulty moving their face after a period of improvement in facial movement, which can make them worry that the facial paralysis is returning. However, actual recurrence of facial paralysis of the Bell Palsy type is uncommon.

New difficulty in moving the face is more likely the result of increasing the strength of the facial muscles without improving the ability to coordinate and control the movement. To keep this from happening, your physical therapist will show you what facial movements you should avoid during recovery. For instance, the following might lead to abnormal patterns of facial muscle use:

Your therapist will coach you to use your face as naturally as possible, without trying to restrict facial expressions because they look “different.”

Real Life Experiences

Doris W. wakes in the morning and washes her face. She’s surprised to find that she gets soap in one of her eyes. Then, when she brushes her teeth and rinses, she feels the water running out of only one side of her mouth. Doris looks in the mirror and sees that on one side of her face, her cheek is drooped, and one corner of her mouth is lower than the other. Her first thought is that she’s having a stroke, and she’s even more concerned when she tries to speak and has trouble saying certain words. Because she has no other weakness of the arms or legs or changes in vision or ability to think, a stroke is less likely.

What does she do next?

First, she gets immediate medical attention in an urgent care center or the emergency department of her local hospital. This assessment is necessary to diagnose the problem as paralysis or partial paralysis of only one side of her face and to rule out other causes of facial weakness, such as stroke. Early treatment of facial paralysis due to Bell Palsy is either “do nothing” (wait and see) or prescribe anti-inflammatory or antiviral medications. Doris is instructed to protect the eye from drying of the cornea and is referred to her physician for follow up. Her physician recommends that she see a physical therapist to help her regain normal use and movement of her facial muscles.

Her physical therapist first makes sure that she is protecting her eye appropriately. Doris is using an eye patch, and the therapist shows her how to look down and focus on something, to keep the eye in the downward position, and to close the eye when washing her face or when she’s outside and the wind picks up. Because her paralysis is partial, the therapist begins “facilitation” exercises to keep the lips in a better position for the cheek to lift into a smile (gently press the lips together and continue pressing while attempting to smile). The therapist recommends that Doris try using a straw positioned close to the center of her lips when drinking, which will help the weak side of the lips to “work” with the uninvolved side in sucking.

This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat conditions or injuries. You may want to consider:

You can find physical therapists who have these and other credentials by using Find a PT, the online tool that built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you’re looking for a physical therapist (or any other health care provider):