What is Bell’s palsy?
Bell’s palsy is a sudden weakness of the muscles on one side of the face. The nerve that moves the face is affected, so the mouth droops, the eye does not close well and the forehead may not wrinkle.
It comes on over hours to a couple of days. Even when there is little pain, the change is frightening, because the face is how we talk and smile.
How do I tell it from a stroke?
You cannot reliably tell by looking, so treat a new drooping face as an emergency until a doctor says otherwise.
Go to the emergency department at once if the face droop comes with arm or leg weakness or numbness. The same goes for slurred speech, confusion, trouble seeing, a sudden severe headache or loss of balance. These point to a stroke. Our guide to stroke warning signs lists them.
Even without those signs, a new drooping face needs a doctor on the same day.
What does the doctor do first?
The doctor checks you, rules out a stroke and other causes, and decides on medicines. Treatment for Bell’s palsy is a medical decision, and we follow your doctor’s plan.
The doctor will also talk about eye protection, because an eye that cannot close is at risk. Once you have a diagnosis, physiotherapy can start, and the start date follows your doctor’s advice. If you are unsure whether to wait, ask your doctor. For general guidance, see when to seek medical care.
How does physiotherapy help?
Physiotherapy supports recovery, and does not replace the doctor. Our aims are modest and clear.
- Gentle, regular facial movements, done in front of a mirror.
- Light massage and warmth to ease tight, tired muscles.
- Advice on chewing, drinking and speaking while the face is weak.
- Care of the eye, as your doctor advises.
- Avoiding overuse that causes unwanted muscle tightening.
- Neck and shoulder tension, which builds up from the strain.
- Confidence, so you go back to eating out and being seen.
Our blog on the Bell’s palsy recovery timeline describes what recovery tends to look like.
What does a gentle routine look like?
Keep it short and calm. A routine, done a few times a day, may include the following.
- Raise the eyebrows gently, then relax.
- Close the eyes softly, as far as they go, then relax.
- Smile without teeth, then relax.
- Pucker the lips as for a kiss, then relax.
- Puff the cheeks lightly, then release.
Stop before the face tires or twitches. Use a mirror to keep both sides moving evenly, rather than pulling the strong side harder. We tune the routine to your face and review it each visit.
What helps at home with eating and the eye?
Daily life changes a little for a while.
- Chew on the stronger side and take small bites.
- Use a straw if drinking spills, and check food does not pool in the cheek.
- Brush the teeth well, because food can collect on the weak side.
- Wear sunglasses outdoors and use the eye care your doctor advised.
- Avoid rubbing the eye, and keep dust and fan air away from it.
- Rest. Tiredness makes the face look and feel worse.
Mealtimes with family can feel awkward. A plain word, such as “my face is healing, it will look a little odd for now”, helps relatives relax.
When should you seek urgent help?
See a doctor straight away if the eye becomes red, painful or blurred, or feels gritty because it will not close. The same applies if the weakness spreads, worsens after the first days, or appears on both sides.
Also go to the emergency department for any sudden limb weakness, speech trouble or severe headache. If there is little sign of improvement after the time your doctor expects, go back for review. Your doctor may refer you to a specialist.
How do we arrange it?
Home physiotherapy across Ipoh is available now, and our Canning Garden centre near Fatimah Hospital is opening soon. Message us once a doctor has seen you, with when the face changed and what bothers you most.
We reply with how a first visit would run and a quote. Home and centre prices differ, and no price list is published yet. For other nerve-related conditions, see neurological rehabilitation.