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   BELL'S PALSY FAQs
moment any movement returns.
  THE FACIAL NERVE
Therapists who specialize in facial
retraining can offer further assistance with
programs customized to your specific   THE FACIAL MUSCLES

needs. Facial neuromuscular retraining is

a highly specialized field, and involves   CAUSES OF FACIAL PALSY
training beyond the standard curriculum
for physical therapy. There is no   RAMSEY HUNT SYNDROME
substitute for the experience of certified
facial NMR therapists, and the tools   SYMPTOMS
available with physical therapy, such as
EMG feedback.
  RESIDUAL EFFECTS

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   TREATMENT
in incomplete recovery or leave residuals.
These exercises are not meant to replace
a customized program under the
  EYE PROTECTION

supervision of a professional facial

retraining therapist - If you feel you need   FACIAL EXERCISES
professional help, don't hesitate to get it.
  BOTOX FOR RESIDUALS
GENERAL GUIDELINES FOR OLD AND
NEW CASES...   SURGICAL OPTIONS
Keep a couple of things in mind as you
exercise with Bells palsy ... You need to
be patient, and work the muscles gently.
  FACIAL RETRAINING

The idea is not only to regain motion, but

for the motion to be balanced with the   TREATMENT CENTERS
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   CHAT ROOM
mouth. And check the muscle that runs
down your neck to make sure it doesn't
  LINKS
"pop out". Keep the muscle movements
appropriately isolated. Pay attention to
your face as you exercise - focus on   SITE INFORMATION

watching and feeling what the good side

is doing, and then mentally visualize it on   DISCLAIMER
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   MEMBERS LOGIN HERE

isn't ready for. Movements will elongate

with time.   NOT A MEMBER?

Exercise in short sessions, but repeat the   REGISTER HERE!

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.
FOR LONGTIMERS...
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.
 Starting 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
The face has many muscles, each with its own unique function. Some, but not all, are
controlled by CN-VII. These muscles are known as "the muscles of facial expression". Unlike
other muscles, the facial muscles insert directly into the skin. Contraction of the muscles causes
the skin to move. Signals from the complex array of nerves to the various muscles instruct the
muscles to move in combinations as well as individually. Bell's Palsy temporarily prevents the
nerve from transmitting signals to the muscles, causing weakness or paralysis. Another way the
facial muscles differ from skeletal muscles is that they do not immediately begin to atrophy
from lack of use. Estimates of the time it takes for significant atrophy to begin varies, but it is
now believed to be years before this occurs.

CN-VII is one of 12 pairs of cranial nerves. This explains why not all the facial muscles are
affected. The muscles that close the eyelid are controlled by CN-VII, but the muscles that
control other eye movements and the ability to focus are not. Hence, the dry and wide open,
but otherwise functioning eye. The sense of taste is affected, but tongue motion is not. Skin
sensation may be affected near the ear, but sensation over the rest of the face usually remains
normal. Chewing and swallowing are other examples of functions controlled by cranial nerves
that are not involved with 7th nerve disorders.

The Facial Muscles

 The arrows point in the direction of the muscle pull.

Muscle Abbr. Action

C
pulls eyebrows together downward and
corrugator O
medially
R
D
pulls the corner of the mouth downward as
depressor anguli oris A
in frowning
O
D
dilator naris I flares nostrils
N
D
depressor labii
L draws lower lip downward and laterally
inferioris
I
F
frontalis R raises eyebrows
O
 L
levator anguli oris A elevates the angle of the mouth
O
L
levator labii superioris
L raises upper lip and dilates nostril
alaeque nasi
A
L
levator labii superioris L raises upper lip
S
M
mentalis E closes and protrudes the lips
N
O
orbicularis oris
O closes and protrudes the lips
inferioris
I
O
orbicularis oris
O closes and protrudes the lips
superioris
S
O
orbicularis oculi
C closes the eye
inferioris
I
O
orbicularis oculi
C closes the eye
superioris
S
P
draws corners of the mouth down, wrinkles
platysma L
neck
A
P
depresses medial corners of eyebrows
procerus R
(frown), wrinkles forehead
O
R
risorius I draws corner of mouth outward as in smiling
S
Z
raises and draws corner of the mouth
zygomaticus major Y
laterally (smile)
J
Z
zygomaticus minor Y raises and everts upper lip
N

Major nerve branches: Temporal (T); Zygomaticus (Z); Buccal (B); Mandibular (M)