Background: James, a 44-year-old IT consultant, woke up one morning with weakness on the left side of his face. Obviously, he was a little worried, but he initially thought it was due to sleeping in an awkward position. Unfortunately, as the day progressed he knew something was seriously not right. He noticed an inability to close his left eye fully, difficulty drinking without drooling, and slightly slurred speech. His initial thought was “have I had a stroke” but this was later ruled out. The hospital and his GP diagnosed him with Bell’s Palsy.

Initial Assessment at Surrey Physio: James was referred to Surrey Physio five weeks after the onset of symptoms. During his initial assessment, our physiotherapist noted:

• Facial asymmetry, with weakness on the left side.


• Reduced eye closure, leading to dryness and discomfort.
• Difficulty pronouncing certain words, particularly those requiring lip movement.


• Weakness in the muscles controlling facial expression, affecting his ability to smile, frown, and raise his eyebrows.

James also reported mild pain around his jaw and ear. While he had started a short course of steroids (prednisolone) prescribed by his GP, he was keen to explore rehab as he was getting concerned that he may not recover.

Treatment Plan: Our physiotherapy approach for Bell’s Palsy varies from patient to patient but is largely focused on facial muscle massage, facial muscle retraining, neuromuscular re-education, and pain management. James’s personalised programme included:

1. Facial Exercises

• Gentle assisted movements to help stimulate the weak muscles.
• Targeted exercises such as raising eyebrows, closing the eyes, smiling, and puckering the lips.
• Mirror therapy to improve muscle control and coordination.

2. Neuromuscular Stimulation:

• Low-intensity electrical stimulation to activate the facial muscles.
• Specific massage techniques to encourage circulation and reduce muscle stiffness.

3. Eye Care and Strategies:

• Lubricating eye drops to prevent dryness due to incomplete eyelid closure.
• Eyepatch use at night to protect the eye while sleeping.

4. Speech and Functional Training

• Techniques and exercises to strengthen the mouth muscles.
• Coordination exercises to improve symmetry in facial expressions.

5. Posture and Relaxation Techniques

• Gentle neck and jaw stretches to alleviate discomfort.
• Relaxation techniques to reduce stress, as stress can exacerbate symptoms.

Progress and Outcome: Over the course of 12 weeks, James saw significant improvement. By week four, he regained partial movement in his left eye and could close it more fully. By week seven, his smile was more symmetrical, and he could drink without spillage. By week ten, he had regained about 90% of his facial function, with only minor residual weakness that continued to improve with ongoing exercises.

Conclusion: James’s case highlights the effectiveness of early intervention and structured physiotherapy in managing Bell’s Palsy. With a combination of facial exercises, neuromuscular retraining, and supportive care, most patients experience substantial recovery.

Find more exercises for Bell's Palsy here.

Other Great outcomes: read this great review from another patient who had Bell’s palsy: