Understanding Bell’s Palsy

By Monica Hallman, PTA, CKTP, LSVT BIG certified
Clinical Director, Barto

Bell’s palsy is a condition that affects the nerves and muscles of the face causing the affected side to sag or droop. This is similar to the weakness of the facial muscles of a CVA or stroke. Most Bell’s palsy patients initially believe that this is the cause of their facial paralysis. Although the symptom of unilateral facial weakness is common to both conditions, a stroke would cause muscle weakness in other areas of the body as well.

Bell’s palsy can happen to anyone, at any age. The cause is idiopathic; which means the exact cause is unknown. Most doctors believe it is due to damage to the ‘facial nerve’ (7th cranial nerve). It could be from a trauma, which causes swelling and places pressure on the nerve, causing it to be compromised. Another cause could be Lyme disease, an infection, or a viral infection such as herpes simplex (cold sores), herpes zoster (chicken pox/ shingles), or influenza B (the flu).

The specific symptoms, which come on suddenly, include mild to total paralysis on one side of the face, usually with a ‘one-sided smile’ and difficulty closing the eye on the affected side. Other symptoms include drooling, pain around the jaw or ear and the affected side of the face, headaches, and increase (or decrease) of tear production.

For most people with Bell’s palsy, the symptoms are temporary and start to improve in a few weeks with complete recovery in approximately six months. A small percentage of patients have symptoms for life but Bell’s palsy rarely will re-occur.

Treatments of symptoms include physical therapy and use of medications, such as corticosteroids, and anti-viral drugs. Physical therapy (PT) is very important to prevent further nerve damage and help strengthen the weakened muscles. Paralyzed muscles can cause permanent contractures from the muscle shortening.

The PT treatment includes modalities, such moist heat, cold pack, and transcutaneous electric nerve stimulation (TENS) for pain relief. Massage, Myofascial Release, and deep tissue manipulation are implemented to relax tightened muscles. Direct current electric stimulation is done to inactive nerves to prevent permanent damage and keep muscles active while healing. The physical therapist will teach specific exercises and monitor symptoms and progression of this condition.

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