how effective is physiotherapy treatment for bell’s palsy?

Firstly, what is Bell’s palsy? Bell’s palsy is a term given to the sudden onset of facial muscle weakness. It usually affects one side of the face, and the initial recovery period varies from a few weeks to three months. The exact cause is unknown, but studies have shown that it is the swelling and inflammation of the nerve that controls the muscles down the side of the face, which causes compression as it travels through bone cavities in the skull or can be a result of a reaction that can occur after an infection.

With such a rapid onset (between 24 and 72 hours), Bell’s palsy can be scary and confusing if symptoms are not known and can sometimes be confused with the beginning of a stroke or other facial paralysis. Unlike a stroke, the typical complete one-sided paralysis causes your face to sag, making your smile one-sided and your eye resistant to closing. For the most part, Bell’s palsy is temporary, and recovery can occur within a couple of weeks or complete recovery in six months.

Bell’s palsy symptoms come on suddenly and can include:

• Rapid onset of mild weakness to total paralysis affecting one side of your face and usually occurring within hours or days (in approximately 1% of cases, both sides of the face are affected)
• Ear pain or flu-like symptoms before the onset 
• Headache, sharp pain in the inner ear, or pain around the jaw on the affected side, which may occur during the onset of paralysis
• An altered or impaired sense of taste 
• Increased sensitivity to sound on the affected side 
• Drooling 
• A feeling of facial drooping and inability to make facial expressions such as smiling or closing your eye
• Difficulty in speaking clearly with particular pronunciation

If you are worried that you or another may be experiencing a stroke or mini-stroke, think FAST (this stands for Facial drooping, Arm weakness, Speech difficulties and Time to ring the emergency services). 

Who is affected by Bell's palsy? 

“Up to 24,000 people per year in the UK are affected by Bell’s palsy.”

For a condition that many are not aware of, 24,000 people per year are quite a significant number of the population who may incur Bell’s palsy at some point in their lifetime. Bell's palsy affects both men and women equally, mostly presenting between the ages of 15 and 45, though cases have been recorded outside of that age bracket.

Although no conclusive cause for Bell’s palsy has been made, studies have shown a high relation to it appearing as a reaction after a viral infection. Some of these viral infections include:

• Chickenpox and shingles (herpes zoster) 
• Cold sores and genital herpes (herpes simplex) 
• Mumps (mumps virus) 
• German measles (rubella) 
• Flu (influenza B) 
• Hand, foot, and mouth disease (coxsackievirus) 
• Inner ear infection (acute otitis media) 
• Infectious mononucleosis (Epstein-Barr) 
• Respiratory illness (adenovirus) 

Bell’s palsy has also been associated with those who are experiencing a depleted immune system, pregnancy or stress. The swelling and inflammation that viral infections can cause lead to the compression of the facial nerves as they pass through the skull, which results in Bell’s palsy and facial paralysis. Though Bell’s palsy may be a reaction to any of the above causes stated, it is not definite that if a viral infection is experienced, it will result in an episode of Bell’s palsy.

How is Bell’s palsy diagnosed? 

Bell’s palsy is diagnosed by way of elimination rather than nomination, and a variation of tests are used to determine which course of action needs to be taken. A doctor may examine you in the following ways:

1. Movements
2. Bloods
3. Image screening
4. ENT

Movements 

A practitioner will ask you to perform a range of exercises to demonstrate the lack of movement and determine the scale of paralysis or damage. These could include actions such as closing your eyes, puckering your lips, raising your eyebrow, or even trying to smile. 

Bloods 

Your doctor may request blood samples to test for Lyme disease, diabetes, or HIV to eliminate any underlying infection or disease.

Image screening 

This may be used to rule out the possibility of a tumour or skull fracture. Usually, a magnetic resonance imaging (MRI) scan or computerised tomography (CT) scan is scheduled.

ENT 

Your doctor may refer you to an Ear, Nose, and Throat specialist for them to detect the location and extent of any nerve damage sustained. This is usually done through electromyography (EMG), which measures the electrical activity within the muscles in response to stimulation.

If at any time you suspect that you may have Bell’s palsy, it is essential that you speak to your general practitioner, ring the NHS helpline (111) or seek to make your way to your nearest A&E within 72 hours.

What treatments are there for Bell’s palsy? 

Bell’s palsy recovery is unique to each person, and just like the inconclusive causes, recovery is not determined by one route only.  You may be able to receive one treatment, but you do not need any at all. You may also be advised to use combination treatments to assist in a speedy recovery.

Depending on the severity of your nerve damage and previous medical history, your doctor may discuss any of the following treatments with you:

1. Medication 
2. Physiotherapy 
3. Electrotherapy
4. Surgery 

Medication

• Corticosteroids - anti-inflammatory drugs that can be administered to reduce the swelling of the nerve fibres and ease the compression as they pass through skull cavities.
• Antiviral drugs - there is little evidence that antivirals work well alone; usually teamed with a steroid, they can help those with severe Bell’s palsy.

Physiotherapy 

After an episode of Bell’s palsy, muscles will be both weakened and shortened by paralysis and may need physical therapy to improve strength and muscle tone.

Your physiotherapist will be able to guide you through facial exercises or massages that will enable you to reintroduce movement to engage both the facial muscles and nerves and resume normal function.

Electrotherapy 

Electrotherapy, such as a Transcutaneous Electrical Nerve Stimulation (TENS) machine or Electronic Muscle Stimulation (EMS) unit, can be used in combination to help with rehabilitation from Bell’s palsy.

EMS machines stimulate the muscle through tiny electrical pulses delivered through electrode pads. Working on muscle tone, the machine rhythmically contracts and relaxes the muscle.

TENS machines offer noninvasive, drug-free pain relief. By sending soothing pulses along the nerve fibres via skin pads, the pulses suppress pain signals to the brain while encouraging the body to produce increased levels of its own endorphins and enkephalins. 

Surgery 

This measure is one of the last treatments to be considered, as high-risk factors are involved and could potentially result in further damage to sight, audio or nerve fibres.  Decompression surgery is controversial, and on rare occasions, cosmetic surgery is considered to reduce deformities or to rectify the damage caused. 

Overall, studies have shown the effectiveness of electrotherapy combined with other treatments. Patients showed significant improvement in physical and mental well-being while receiving electrotherapy treatment for Bell’s palsy.

Frequently Asked Questions About Bell's Palsy and Physiotherapy

How long does Bell's palsy typically last?

The duration of Bell's palsy varies from person to person. Most people start to see improvements within a few weeks, with complete recovery often occurring within 3 to 6 months. However, in some cases, symptoms may persist for longer periods. Early intervention with treatments like physiotherapy can potentially speed up the recovery process.

Can Bell's palsy recur?

While uncommon, Bell's palsy can recur in some individuals. Studies suggest that the recurrence rate is around 7-8%. If you've had Bell's palsy before, it's important to maintain good overall health and consult with a healthcare professional if you notice any recurring symptoms.

Are there any home remedies for Bell's palsy?

While professional medical treatment is essential, some home remedies may complement your recovery:

• Facial exercises as recommended by your physiotherapist
• Applying warm compresses to relieve pain
• Maintaining good eye care if the affected eye doesn't close properly
• Getting adequate rest to support your body's healing process

What are the long-term effects of Bell's palsy?

Most people recover fully from Bell's palsy without long-term effects. However, in some cases, individuals may experience:

• Mild facial weakness or asymmetry
• Synkinesis (involuntary facial movements)
• Persistent changes in tear or saliva production

How does physiotherapy help with Bell's palsy recovery?

Physiotherapy plays a crucial role in Bell's palsy recovery by:

• Improving facial muscle strength and coordination
• Preventing muscle atrophy and contractures
• Enhancing facial symmetry
• Retraining neural pathways for improved facial function
• Providing education on self-management techniques

A qualified physiotherapist can develop a tailored treatment plan to address your specific needs and optimize your recovery.

For personalized advice and treatment for Bell's palsy, consult with our experienced physiotherapists at CK Physiotherapy in London. We offer expert care and evidence-based treatments to support your recovery journey.

Contact CK Physiotherapy for a Consultation 

If you wish to find a trusted physiotherapist in London or want to find out more about how electrotherapy can be used to help you overcome Bell’s palsy or any other ailment. Please do not hesitate to contact CK Physio to speak to one of our experienced physiotherapists at our Ealing branch.

Our physiotherapists have years of experience and will be happy to assist you. After a dedicated consultation, we can give you precise and appropriate information and assess and advise you on the best course of electrotherapy treatment for your personal circumstance at a reasonable cost.