Best Physical Therapy Exercises For Bell’s Palsy
Manhattan Physical Therapy
Bell’s palsy is a sudden condition that causes weakness or paralysis on one side of the face. It happens when the seventh cranial nerve (facial nerve) becomes inflamed, compressed, or irritated. This nerve controls facial expressions such as smiling, blinking, chewing, and speaking. When it stops working properly, facial muscles can no longer respond normally.
In the United States, Bell’s palsy affects an estimated 30,000–40,000 people each year, most commonly adults between 20 and 40 years old. It occurs more often in people with diabetes, weakened immune systems, and in pregnant women, especially during the third trimester.
Bell’s palsy is considered a diagnosis of exclusion, meaning doctors must first rule out serious conditions like stroke, brain tumors, or infections before confirming it. While the exact cause is unknown, research strongly links Bell’s palsy to viral reactivation, particularly herpes simplex virus type 1 (HSV-1). Other viruses such as chickenpox and Epstein-Barr may also play a role.
Symptoms usually appear quickly and may include:
Facial drooping on one side
Difficulty smiling or closing the eye
Drooling or trouble chewing
Slurred speech
Ear pain or ringing
Reduced sense of taste
These symptoms can feel alarming, which is why early medical evaluation is critical.
How Physical Therapy Helps Bell’s Palsy Recovery
Although about 70% of people recover naturally within 3–6 months, recovery is not always complete. Some individuals develop long-term issues such as facial tightness, muscle spasms, or unwanted movements called synkinesis. This is where physical therapy for Bell’s palsy becomes important.
Facial physical therapy focuses on:
Re-activating weakened facial muscles
Improving coordination and symmetry
Preventing abnormal muscle patterns
Reducing stiffness and facial spasms
Research supports this approach. A study published in Neurology found that patients who participated in facial neuromuscular retraining showed better functional recovery than those who did not. Another review in the Cochrane Database of Systematic Reviews reported that facial exercises may improve outcomes, especially when combined with medical treatment such as corticosteroids.
Physical therapy works by encouraging neuroplasticity—the brain’s ability to create new pathways and relearn control over facial muscles. Rather than forcing movements, therapy teaches the face to move correctly again, step by step.
When Should You Start Bell’s Palsy Exercises?
Timing matters. Facial exercises should not be rushed without guidance, but starting at the right time can make a meaningful difference.
Most patients are cleared to begin gentle facial therapy within the first two weeks after diagnosis, once swelling is under control and a physician has ruled out other conditions. Early intervention may:
Improve muscle activation
Reduce the risk of long-term complications
Support faster and more complete recovery
However, doing the wrong exercises too early or too aggressively can increase the risk of muscle tightness and misfiring. That’s why working with a trained physical therapist—preferably one experienced in facial nerve conditions—is strongly recommended before starting a home routine.
Why Bell’s Palsy Exercises Must Be Personalized
There is no single exercise program that works for everyone with Bell’s palsy. Each person presents differently depending on:
Which facial muscles are affected
Degree of nerve involvement
Presence of muscle tightness or spasms
Stage of recovery
A physical therapist begins with a detailed facial evaluation, assessing movements such as:
Eyebrow raising and frowning
Eye closure and blinking
Lip movement and closure
Smiling with cheek activation
Jaw control and tongue movement
Facial expressions and symmetry
Based on this assessment, the therapist creates a customized exercise plan. Some patients need help activating weak muscles, while others need to relax overactive or tight muscles before strengthening begins.
Guided therapy also helps patients avoid common mistakes, such as over-compensating with the unaffected side or reinforcing abnormal movement patterns. When done correctly, facial exercises retrain the brain-to-nerve-to-muscle connection, leading to more natural expressions over time.
Best Physical Therapy Exercises for Bell’s Palsy Recovery
Bell’s palsy exercises are designed to restore controlled facial movement, not force strength. These movements should be slow, intentional, and ideally performed in front of a mirror to provide visual feedback. The exercises below reflect both clinical best practices and the guided approach demonstrated in the referenced physical therapy video, where emphasis is placed on precision, relaxation, and coordination rather than aggressive effort. Always get clearance from your healthcare provider or physical therapist before starting.
Eyebrow and Forehead Movement
This exercise targets the muscles responsible for facial expression and eye symmetry.
How to perform:
Keep your eyes open and gently raise both eyebrows.
If needed, place a finger above the eyebrow on the affected side to assist the movement.
Slowly lower the eyebrows back down.
Next, gently frown and try to draw the eyebrows toward each other.
Eyebrow lift: 15 repetitions
Frowning motion: 10 repetitions, 1–3 sets
Improves forehead control, supports eye symmetry, and reduces brow drooping.
Eye Opening and Closing Exercises
Difficulty blinking or closing the eye is one of the most common and risky symptoms of Bell’s palsy.
How to perform:
Open both eyes wide, as if surprised.
Gently close both eyes as tightly as possible without engaging other facial muscles.
Focus on smooth, controlled motion.
15–30 repetitions, 1–3 sets
Supports blinking mechanics, protects eye health, and improves eyelid control.
Smiling Exercises (Open and Closed Mouth)
Smiling exercises are essential for restoring cheek, lip, and jaw coordination.
How to perform:
Start with an open-mouth smile.
Use a finger to assist the affected side if needed.
Hold the smile for 5 seconds, then relax.
Repeat using a closed-mouth smile.
10 repetitions each, 1–3 sets
Retrains the zygomatic and cheek muscles while improving symmetry and confidence in expression.
Lip Pursing and Pouting
These movements help restore control needed for speaking, eating, and drinking.
How to perform:
Pucker your lips as if whistling or blowing a kiss.
Lightly assist the affected side using your fingers.
Hold briefly, then relax.
15 repetitions, 1–3 sets
Improves lip strength, articulation, and coordination.
Cheek Puffing Exercise
This exercise promotes cheek activation and facial balance.
How to perform:
Keep lips closed and puff one cheek out.
Hold for a few seconds, then relax.
Alternate sides.
15 repetitions, 1–3 sets
Encourages cheek muscle engagement and supports facial symmetry.
Nostril Flaring
This movement targets small but important muscles around the nose.
How to perform:
Flare both nostrils outward.
Assist the affected side with your finger if necessary.
10 repetitions, 1–3 sets
Enhances nasal symmetry and supports overall facial coordination.
Tongue Mobility Exercises
Tongue control is essential for speech and swallowing.
How to perform:
Stick your tongue out and move it upward toward the roof of your mouth.
Then move it downward toward your chin.
Next, trace the roof of your mouth from front to back.
10 repetitions, 1–3 sets
Improves oral coordination and functional speech movements.
Bell’s Palsy Massage and Muscle Relaxation Techniques
For patients experiencing facial tightness, spasms, or discomfort, facial massage may be incorporated into treatment.
Massage focuses on:
Lower facial muscles (lips and mouth)
Cheeks
Forehead and brow area
A therapist typically teaches these techniques in-clinic before recommending home use. Massage can:
Reduce muscle stiffness
Improve circulation
Support nerve healing
Improve facial symmetry
Some therapists may recommend applying moist heat after massage to further relax tight muscles. Massage should always feel gentle—never painful.
How Often Should You Perform Bell’s Palsy Exercises?
Consistency matters more than intensity. Most physical therapists recommend:
Performing exercises 2–3 times per day
Short, focused sessions rather than long routines
Stopping if fatigue, frustration, or unwanted movements appear
Overworking facial muscles can slow progress. Quality and control are key.
Are Bell’s Palsy Exercises Really Effective?
For many patients, yes—when done correctly and under professional guidance. Studies show that facial neuromuscular retraining:
Improves voluntary muscle control
Reduces abnormal movement patterns
Supports long-term facial function
Outcomes vary depending on severity, timing, and adherence to therapy. Patients who follow a therapist-guided plan consistently tend to experience better coordination and symmetry than those who rely on unsupervised routines.
When Additional Treatment May Be Needed
If facial paralysis does not improve within six to eight months, further treatment options may be considered, including:
Botox for muscle imbalance
Advanced neuromuscular therapy
Facial reanimation procedures
Even in these cases, physical therapy remains a critical part of recovery and is often used alongside medical or surgical treatment. Call Manhattan Physical Therapy at (212) 213-3480 today to schedule your one-on-one Bell’s palsy evaluation and take the next step toward restoring natural facial movement.
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