Before you start to exercise, get familiar with your face. We suggest you print the diagram of the muscles and the list of the muscles’ actions. Refer to them as you exercise. Use them to get to know your facial muscles and what each muscle is doing as it moves. This can help you learn to isolate muscle actions as well as coordinate multiple muscle movement. Regaining balanced, symmetrical movements are key to restoring the face as it was before.
Moist heat and massage can be part of the routine at all stages of recovery. Mirror feedback is important from the moment any movement returns.
Therapists who specialize in facial retraining can offer further assistance with programs customized to your specific needs. Facial neuromuscular retraining is a highly specialized field and involves training beyond the standard curriculum for physical therapy. There is no substitute for the experience of certified facial NMR therapists, and the tools available with physical therapy, such as EMG feedback.
The majority of Bell’s palsy cases will resolve without intervention or exercise. Patience is more important during recovery than pushing to exercise muscles that are likely to return to full function without assistance. Some cases will result in incomplete recovery or leave residuals. These exercises are not meant to replace a customized program under the supervision of a professional facial retraining therapist – If you feel you need professional help, don’t hesitate to get it.
General Guidelines for Old and New Cases
Keep a couple of things in mind as you exercise with Bells Palsy … You need to be patient and work the muscles gently. The idea is not only to regain motion but for the motion to be balanced with the good side. Don’t force things to the point that the two sides pull against each other. If you see a motion pulling other muscles that shouldn’t be moving, back off a little, and freeze it at that point, and relax the muscles that shouldn’t be moving. Keep your eyes on those eager-beaver muscles in the cheek area as you work your eye or mouth. And check the muscle that runs down your neck to make sure it doesn’t “pop out”. Keep the muscle movements appropriately isolated. Pay attention to your face as you exercise – focus on watching and feeling what the good side is doing, and then mentally visualize it on the Bell’s palsy side and try to recreate it in tiny increments. Use a mirror – the feeling of motion you get while exercising can be very deceptive, so this is important. The mirror will also help you avoid letting the good side overcompensate by moving in an exaggerated way.
Remember not to push it – better to hold a position at the point it can go without inappropriate muscles jumping in to help than to try too hard to do things your face isn’t ready for. Movements will elongate with time.
Exercise in short sessions, but repeat the routine 2-3 times a day, more if you can. Quantity is not as important as quality, so don’t do your exercises when you’re tired.
** It’s better to exercise correctly just a few times than to do it incorrectly many times.**
During the earliest days of Bells palsy, when muscles are completely flaccid, it’s probably advisable to limit therapy to moist heat (to ease soreness and reduce swelling), massage (also to ease soreness, plus to provide a degree of motion & stimulation to the muscles and increase circulation) and mental exercises (to retain the “memory” of facial motions).
Facial muscles are not at risk of permanent atrophy for quite a long time. Focus your exercise energy on maintaining the brain-to-nerve-to-muscle connection. This is more important than the physical motions your muscles did before and will do again. The signal begins with your brain when you’re healthy – you can use your mind to help maintain the connection while your body rests and begins to recover. Do this by visualizing normal movement. Use your mind to see it, sense it and feel it. This will help maintain the memory of the signal that must be transmitted to the muscles when the time comes for everything to start to move. Avoiding excessive facial exercises in the early days will give the nerve time to recover from the trauma, start the healing and regrowth processes, and help to avoid promoting synkinesis. Pushing muscles that have been weakened with Bell’s palsy before they’re capable of correctly coordinated movement may promote synkinesis and incorrect movement patterns that are difficult to “unlearn”. Remember that you’re recovering from an injury. Give your nerve the chance to rest and heal just as you would if it were a broken bone.
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