Things you can do

Muscle releases

Muscle releases are very important in preventing facial muscles becoming short and tight, so daily muscle releases are an essential part of rehabilitation (link to post on muscle releases).  If you are dedicated to a daily rehabilitation programme you will be doing all you can to prevent the muscles from becoming short, thick, stiff, immobile and painful.  When the nerve does recover the muscles will be in optimum health to carry out movement.  In many cases, the nerve may have recovered but the muscles are just too tight and stiff to move rather than weak.

Relaxation exercises

Keeping the face relaxed and practicing facial relaxation exercises is an excellent way to minimise synkinesis.  When the facial nerve is damaged and even when it recovers it can behave in a very chaotic way.  The recovering nerve often loses its ability to know when to activate and when to rest.  The result is that the nerve is constantly stimulating the facial muscles even when the face is at rest.  Electrical stimulation is a form of fuel for the muscle.  The result is that the facial muscles receive too much fuel resulting in the muscles becoming bulky and tight. Practicing facial relaxation can help the nerve learn when to rest and when to activate.  Learning to control the rest levels in the face is essential for good muscle health.

Retraining movement exercises 

Movement re-education or facial retraining.  This means relearning normal movement patterns which aim to minimise the development of synkinesis or minimise existing synkinesis.  When the facial nerve is injured and as it recovers, it finds it difficult to coordinate muscle movement properly.  Synkinetic muscles tend to work together rather than do their specific jobs.  Only start practicing facial expressions if you see them happening spontaneously.  This tells you that the nerve is able to send enough electrical information to the muscle to make it move.  When you see some signs of an expression returning, without you having to try, this is the time to start some very gentle, slow and symmetrical exercises [Link to gentle movement exercise video]

Botox 

Botulinum Toxin injections may be recommended to help with muscle tightness and synkinesis.  link to Botulinum Toxin: A treatment for facial palsy. The clinician responsible for the management of your Bell’s palsy should refer you to an appropriate facial palsy service where this type of treatment is available.