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 is 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 recovery. 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.
When its time to start exercising, read the section for longtimers, and follow the same principles, but for these exercises:
• Sniffle. Wrinkle nose. Flare nostrils.
• Curl upper lip up and raise and protrude upper lip.
• Compress lips together. Pucker lips & attempt to whistle.
• Smile without showing teeth; then smile showing teeth.
• Try moving your lips into a small smile slowly. Then gently pucker slowly using equal strength from both sides.
• Draw angle of mouth upward so as to deepen furrow from side of nose to side of mouth.
• Harden (wrinkle) the chin; “stick out” the chin (like a boxer).
• Using your index finger and thumb pull the corners of your lips in toward the center. Slowly and smoothly push out and up into a smile. Continue the movement up to the cheekbone. Use a firm pressure.
• Placing 4 fingertips on the eyebrow rub using a firm stroke up to the hairline. Return downward to the eyebrow. Do the same type of massage in a circular motion on your cheeks and chin, and outward to your ear.
• Try to close the eye slowly and gently, without letting your mouth pull up or your eyebrow move downward.
• Raise eyebrows and hold for 10 -15 seconds (watch out for synkinesis – hold the brow at a point before the corner of your mouth starts to move or your cheek tries to help). Wrinkle forehead.
• Frown and draw eyebrows downward.
• Gently wink with one eye and then the other to the best of your ability. Don’t push it.
• Open eyes widely, but without involving your eyebrow. Stop if you see any inappropriate muscle actions.
Do not chew gum – it exercises the wrong muscles, and may promote synkinesis.
Do try to chew food using both sides of your mouth (at least when you’re eating alone). This will help maintain normal patterns when movement returns.
For Eye Closure
Bell’s Phenomenon may occur. It actually performs a good function, as it helps protect the non-closing eye. With Bells Phenomenon the eyeball turns upward as we attempt to close the eye. So you can think the eye is closed when it actually is not. Have someone observe you while you try closing the eye. If you have Bell’s Phenomenon, concentrate on looking downward toward the floor as you practice eyelid closure.
With longstanding cases of Bells palsy mental work is half the battle. You’re likely to be dealing with residuals such as synkinesis, cross-wiring, hypertonic muscles and spasms. For some people, the muscles have had time to develop inappropriate movements. These movements must be unlearned, and correctly coordinated actions slowly relearned. Muscles that are holding other muscles captive have to be retrained in order to free-up other muscles to move correctly. With slower recoveries from Bell’s palsy, synkinesis, hypertonic muscles and spasms become more likely. The basic idea is to slowly recreate the brain-to-nerve-to-muscle routine. At first the goal is to regain the capability of doing correct movements voluntarily (while mentally focusing on the action). Over a period of time (and hard work) these movements may finally become automatic, natural movements and expressions. Patience and diligence are key – it’s a slow process, and really does have to be worked on daily (or as close to daily as life’s responsibilities and human nature allows).
To relax the cheek: (if the side of your mouth is pulling up and to the side, or your cheek feels tight)
Put your thumb inside your cheek at an angle toward the center of your ear. Grasp the outside of your cheek with your fingers, and pull down and forward (yes, it may hurt just a bit). Hold it for a minimum of 10 seconds; up to 30 seconds is good. Shift the position toward the center and repeat the stretch & hold. Shift still further toward the center and repeat. Shift the position to grasp at an angle from the jaw and pull forward and up; hold. Shift a bit toward the center below your lower lip and repeat.
If you find a thick or sore point as you are doing the exercises or massaging, apply and hold pressure at that spot for 15-20 seconds to help relax the muscle or clear a spasm.
To help isolate eye and mouth movements
• Close and compress your lips (lightly!). While doing this, observe in the mirror the unwanted eye muscle movement. Release, and then lightly compress your lips again. Maintain the lip compression at a point just before your eyelid starts to become involved, and focus on relaxing the muscles around the eye. Very small movements at first – remember that with time you will be able to take the movement farther without involving your eye. Have patience.
• Pucker your lips, using the same technique as for compressing them.
• Snarl, using the same technique.
• Smile (again, start small!). Watch your eye area, particularly the lower lid. Find the point that it starts to move. Then concentrate on the smile in your mind first, let your mouth follow the thought, and hold at the point where the eyelid is not yet involved. Also watch the neck muscle and don’t let it pop out.
• Practice speaking in front of a mirror, repeating words that use M, B, F and P while keeping your eyelids open. In the beginning, speak softly and slowly.
• Raise your eyebrows evenly on both sides. Stop when the corner of your mouth starts to move, hold for 15 seconds while keeping the muscles around your mouth relaxed.
• Stretch the neck muscle by tilting your head to the side and slightly back, hold for 10 seconds. Do it again to the other side.
** If you have any cervical spine problems, speak to your doctor before doing the neck exercise **
• Gently open your eye as widely as you can without raising your eyebrow or letting your lower lid pull up. Hold for 15 seconds.
• tarting with lips slightly open, mentally concentrate on relaxing the chin dimple. Do the same thing with lips closed.
• Pull your lower lip down (take it forward and down in a circular move) evenly on both sides. Don’t let the good side take control of the effort. Keep the eye open, and keep the neck muscle relaxed. Hold 15 seconds.
• Massage your face (both sides) using firm circular motions. Start in the center and work your way out. Massage with the circular motion at your forehead, cheeks, nose, and chin. Then follow the jaw line from your mouth outward as well as from your chin outward.