Facial Nerve Palsy - How physiotherapy can help

Working with a physiotherapist with training in facial nerve rehabilitation can play an important role in recovery from facial nerve palsy—particularly when progress is slower than expected or symptoms persist. In this month’s blog, The Rehab Team explores how physiotherapy can support recovery and guide the process in a meaningful way.People often describe dizziness in different ways.

Facial palsy is not simply a problem of muscle weakness. It is a complex condition that affects how the nerve, muscles, and brain work together. Effective rehabilitation focuses on restoring this connection through a structured, individualised approach—helping to improve not just movement, but the quality and coordination of that movement over time.

If you would like to read more on facial nerve palsy’s include causes, symptoms and recovery - see this blog post.

Why rehabilitation matters

As the facial nerve heals, the signals between the brain and muscles can become disrupted or inconsistent.

This can lead to:

• Weak or delayed muscle activation

• Muscle tightness or stiffness

• Poor coordination of movement

• Synkinesis (unwanted linked movements)

Facial rehabilitation aims to address the physical, functional, psychosocial challenges and neurological aspects of recovery—its not  just about strength!  How a facial nerve palsy recovers can vary and depends on the cause of the palsy, the severity of the nerve injury and the stage of recovery.

What does physiotherapy involve?

Facial rehabilitation is highly individualised which means everyone's rehab looks a little different.  However, there are some key components that are consistently recommended when seeing a physiotherapist:

1. Comprehensive assessment

Your first session is focused on understanding your specific presentation and setting up a plan for your entire rehabilitation plan. This may include:

• Observation of facial symmetry at rest and during different movements

• Assessing muscle tone (floppy vs tight)

• Identifying any abnormal, overactive or compensatory movements

• Reviewing eye function and safety

2. Education and guidance

Education is a key part of treatment and often is the first part of your treatment plan. Some topics you will be guided on could include:

• How the facial nerve recovers

• What stage of recovery you are in

• What to do—and importantly, what not to do 

• Advice on how to look after your eye and mouth

A good example of this - in early recovery, movement exercises are often not appropriate. There is a risk that if you over exaggerate or force facial movements that this can lead to increased tightness, synkinesis and imbalance. 

3. Facial rehabilitation exercises

As recovery progresses, exercises may be introduced to help restore balanced facial movement, improve symmetry and retrain specific muscle activation. These exercises are often gentle, specific and focussed on movement quality rather than effort. 

Taping, massage and stretching are commonly used to help reduce stiffness, tightness and improve comfort levels. This can include facial massage, gentle stretching and relaxation techniques. 

4. Neuromuscular retraining

A key component of rehabilitation is retraining how the brain controls the face. After all, most of our facial expressions are automatic - we don’t think about it!

This may involve relearning how to isolate muscle movements, reducing overactivity in certain muscles and improving timing and coordination.

5. Home exercise programme

A large part of recovery happens outside of our physiotherapy sessions. The Rehab Team will guide you through a personalised programme which may include 

Your therapist will guide you through a personalised programme, which may include a range of daily exercises, taping, massage techniques or relaxation strategies. 

Day to day consistency with completing your exercise programme is important.

The role of Physiotherapy goes beyond movement and muscle strength in facial nerve palsy rehabilitation. Physiotherapy is not just about improving facial movement quality, it also plays an important role in building confidence, supporting emotional adjustment and helping people return to everyday activities. 

Facial nerve palsy recovery is not just about waiting for movement to return. It is about guiding the process—at the right time, in the right way,  with a supportive team. 

If you or a loved one have been diagnosed with facial nerve palsy and you feel like:

•  Your recovery has slowed or plateaued

• Your movement feels tight, stiff or uncoordinated

• You notice unwanted movement (synkinesis)

• Symptoms are impacting your confidence or daily life

• Or you would just like experienced, clinical support and guidance in your rehabilitation journey;

Please Contact The Rehab Team to arrange an initial assessment. The Rehab Team is an in-home Neurological Physiotherapy service, assisting clients within their own homes in Tauranga. We also assist clients living around New Zealand through online appointments.

Want to know more?

Link to our other blog posts.