We rely on our facial muscles for many essential daily activities like speaking, smiling, eating, blinking our eyes and much more. When disease or trauma causes the loss of or changes to these abilities, it can be scary.
In this article, we will aim to provide an understanding of facial palsy (paralysis of the muscles of the face), including symptoms, causes and treatment including how physiotherapy can help you to regain facial movement.
Table of Contents
- What is Facial Palsy?
- What Causes Facial Palsy?
- Signs and Symptoms of Facial Palsy
- Potential Treatment Options
- Facial Palsy Red Flags
- Conclusion
What is Facial Palsy?
Facial palsy refers to paralysis of a part or the entirety of the muscles of the face. This is often due to damage to the seventh cranial nerve also referred to as the facial nerve. This nerve controls facial expression as well as other functions including creating tears, allowing you to speak and taste and many more.[i]
Symptoms of facial palsy may appear suddenly or gradually and may resolve on their own after a period of weeks. In some cases, the effects can have more permanent impacts. Physiotherapists can help you build a personalized treatment plan to help your facial palsy.
What causes Facial Palsy?
There are many potential causes of facial palsy. These may include:[ii]
- Bell’s palsy
- Tumor
- Trauma
- Lyme disease
- Ramsay Hunt Syndrome
Signs and Symptoms of Facial Palsy
Facial palsy can look and feel different to every person, signs and symptoms may include:[iii]
Appearance and movement
- Difficulty or inability to close the eye
- Difficulty moving the lips meaning smiling, puckering, or whistling can become difficult
- The lower eyelid may sag or turn outward
Functional effects
- Trouble keeping food and drink in the mouth, since a proper lip seal is needed
- Less clear speech, particularly with sounds that require the lips to meet (b, p, m, v, f)
- A dry, gritty feeling in the affected eye
Other effects
- Reduced tear production, increasing the risk of eye irritation and if untreated, corneal damage
- Sensitivity to loud sounds
- Altered sense of taste
Facial Palsy Treatment
Physiotherapy for Facial Palsy
A physiotherapist will meet with you and assess your ability to move your face by checking your current facial movements such as movement of the eyebrow, eye closure, ability to use the cheek in smiling, the ability to raise or lower the lips among others.[iv]
They will gain a medical history gathering information about when your symptoms began and what makes them worse or better. With all this information, your therapist will build a custom treatment plan to help you regain healthy movement patterns.
Often the first treatment provided is education about eye care as facial paralysis can impair your ability to lubricate your eyes due to difficulty fully closing the eye. This care may include information about eye drops or ointment.
The physiotherapist will also work with you on exercises to retrain the connections between your brain and your facial muscles. This is called neuromuscular retraining and will help you to refine your facial movements such as your ability to move your mouth to speak and use facial expressions. They will also help to prevent involuntary facial movements that accompany voluntary ones, such as an eye closing when you smile.
Massage for Facial Palsy
Your healthcare provider may also discuss and prescribe facial massage exercises. This may include massaging your face including your cheeks and forehead to try to stimulate muscle movement as well as to help prevent stiffness and to improve blood flow.
Some physiotherapy clinics may also have registered massage therapists experienced in neurological injury rehabilitation that can provide these services.
Facial Palsy Red Flags
When should I see my doctor?
- Facial paralysis on both sides of your face
- No recovery after 3-4 months
- History of cancer related to the head or neck
- Gradual onset that takes more than 72 hours
- Initial recovery and then regression
- Sparing of forehead movement
- Ear pain with or without a vesicular rash
- Dizziness or double vision
- Bullseye rash, indicative of Lyme disease
- Mass in the ear, parotid gland, or neck
- Recurrent Bell’s palsy
Conclusion
Facial palsy can be a challenging and sometimes unpredictable condition, but recovery is possible for many people, particularly with appropriate assessment and support. Physiotherapy can play an important role in helping individuals understand their symptoms, optimize facial movement, manage muscle tension, and address functional challenges as recovery progresses.
At Propel Physiotherapy, we have trained therapists with experience treating Bell’s palsy. We will ensure that you have a treatment plan that allows you to achieve the best possible results quickly and safely.
References
[i] Cleveland Clinic Staff. (2024, July 22). Facial Nerve Cleveland Clinic.
[ii] Physiopedia Staff. (2026, March 23). Facial palsy – physiopedia. Physiopedia.
[iii] Cleveland Clinic Staff. (2026, January 23). Facial paralysis: Causes, symptoms & treatment. Cleveland Clinic.
[iv] Khan AJ, Szczepura A, Palmer S, Bark C, Neville C, Thomson D, et al. Physical therapy for facial nerve paralysis (Bell’s palsy): An updated and extended systematic review of the evidence for Facial Exercise Therapy. Clinical Rehabilitation. 2022 Jul 5;36(11):1424–49. doi:10.1177/02692155221110727
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