Bell’s Palsy: It’s All About Time

By: Breanna Salazar, PT, DPT, Barnabas Health Ambulatory Care Center

You may have heard the name, but not many people actually know what Bell’s palsy is. Named after Sir Charles Bell, Bell’s palsy is an idiopathic facial paralysis due to dysfunction or swelling of the facial nerve. There is currently no known cause to Bell’s palsy, however it has been linked to viral infections, pregnancy and preeclampsia, stress, and certain autoimmune disorders. Bell’s palsy is rare in the United States, with <200,000 cases identified annually.

The facial nerve, or Cranial Nerve VII, is responsible for controlling the muscles of facial expression as well as sensation of taste from the anterior 2/3 of your tongue. Initial symptoms of Bell’s palsy may present similarly to a stroke, and will present over 24-72 hours. Bell’s palsy typically affects only one side of the face, however it may present bilaterally in rare cases. Symptoms vary individually, but may include:

  1. Weakness from mild to total paralysis of facial muscles on one side of the face
  2. Changes in taste
  3. Dryness and/or excessive tearing of the affected eye
  4. Drooling from the affected corner of the mouth
  5. Difficulty with certain speech sounds

The first step you should take if you notice symptoms is to seek medical attention in order to rule out other pathologies. Common early treatments for Bell’s palsy typically include a course of oral corticosteroids with or without an anti-viral medication, eye protection measures such as use of an eye patch or taping your eye closed, and analgesics such as Tylenol or Advil for any potential pain management.

Most cases of Bell’s palsy will spontaneously recover within the first three to six months. However, with more severe cases, some symptoms such as facial weakness or tightness may persist. The most common long term side effect post-Bell’s palsy is synkinesis, which is an involuntary co-contraction of a facial muscle that occurs during an unrelated voluntary movement. Usually people notice this when they smile or eat, and their eye closes.

So, is there a way to avoid synkinesis? The answer, much like the condition, is complicated and usually depends on the severity of the initial symptoms. However, if it does occur, it can be treated!

Where does physical therapy come in to play? Really, my role in your recovery will vary depending on when you seek out physical therapy. In early stages, treatment is generally focused on pain management, education on managing your symptoms day-to-day, and early gentle exercises. If you seek out physical therapy in the later stages of Bell’s palsy for management of persistent symptoms, treatment will be focused more on decreasing tightness that may be causing some of your lasting asymmetries, and honing in on re-teaching your facial muscles the correct movement patterns.

At the end of the day, the most important factor in your recovery is time…and patience.

Bonus fact about bells: The Tsar bell, located in Moscow, is the largest bell currently in existence weighing 180 tons. It has never been rung!

Breanna Salazar, PT, DPT

Doctor of Physical Therapy


Bree is a physical therapist at the Barnabas Health Ambulatory Care Center in Livingston. She treats patients with both orthopedic and neurological conditions, with a special interest in craniofacial pain and temporomandibular joint dysfunctions. Bree completed her BS in biology at Ramapo College of NJ in 2014, and received her doctorate in physical therapy at Rutgers University in 2016. She completed LSVT Big certification in 2020 and is actively working towards her CCTT from the Physical Therapy Board of Craniofacial and Cervical Therapeutics. When she is not in the clinic, she enjoys walking with her dogs, spending time with family, and knitting.

The Saint Barnabas Medical Center Rehabilitation centers are open and ready to help you achieve your goals. With four locations in West Orange, Millburn and Livingston, the experienced and compassionate staff at Saint Barnabas Rehabilitation offers adults and children the specialized care they need to resume an active life after surgery, injury or illness. They are committed to providing patients with the most advanced services in a safe, caring and soothing environment. For high-risk patients who are unable to visit in person, telehealth is an option. Patients do not need a prescription for physical therapy services.

For more information, or to schedule an appointment, call 973-322-7500.