Do facial exercises help to reduce synkinesis after Bell’s palsy and Ramsay Hunt Syndrome?

Facial synkinesis is a common complication that follows a long recovery from peripheral facial palsy (such as Bell’s palsy and Ramsay Hunt Syndrome). Often, to reduce synkinesis, a patient is prescribed facial exercises.

In this article, we would like to express our opinion based on our knowledge and private research on synkinesis, if facial exercises can help to reduce synkinesis.

Estimated reading time: 7 minutes

Important notice: The purpose of this article is to share our opinion and inform of the reasons behind it, in order to challenge the current paradigm in rehabilitation after facial palsy. We are all unique, and there is no one-size-fits-all solution. If you are currently following any measures, and you see positive results, please continue with these methods as long as you are benefiting from them.

Causes of synkinesis

First, a statement: Synkinesis, in our opinion, are not caused by your facial muscles, nor by your facial nerve.

Synkinesis are a habit, that originate in your brain. This habit develops during the long recovery period when you cannot move your facial muscles due to the conduction block.

Therefore, according to our opinion at Crystal Touch Clinic, whatever you do only to your facial muscles or only to your facial nerve, it will not help to reduce synkinesis, because their cause lies within the brain.

To understand why facial exercises are usually recommended after Bell’s palsy and Ramsay Hunt Syndrome, let’s see how they started.

Origin of Bell’s palsy exercises

The nature of exercises used for rehabilitation after Bell’s palsy that involve making certain facial expressions, pronouncing certain sounds, etc. are similar to the exercises prescribed after a stroke.

In the case of a stroke, such exercises are helpful and can enable patients to produce facial expressions. However, there is a very important distinction between a stroke and peripheral facial palsy (Bell’s palsy, Ramsay Hunt Syndrome).

Stroke vs. Bell’s palsy

During a stroke, a part of our brain becomes injured. This causes the brain to be unable to move some parts of our body, including some facial muscles.

In the case of peripheral facial palsy, such as Bell’s palsy and Ramsay Hunt Syndrome, the brain is not injured. Only the facial nerve becomes damaged. You can imagine the facial nerve as a “wire” that connects the brain to the facial muscles. When the wire is damaged, it cannot conduct signals, so the muscles do not move. After a certain amount of time, the facial nerve recovers, and the signals are passing to the facial muscles again.

However, during the long recovery time, some changes happen in the way our brain send signals to the facial muscles. So, although the wire is functioning, and the muscles are working, the brain starts sending different signals.

Facial exercises after a stroke vs. Bell’s palsy

The exercises used after the stroke try to reproduce certain movements, so that the uninjured part of the brain, using neuroplasticity, can take over the functions of the injured part. At least partly. Such exercises can help the patient return some movements to body parts, including facial expressions.

During the stroke, using facial exercises, the brain is creating new pathways to carry the signals to the facial muscles.

During facial palsy exercises, the brain uses existing pathways. It is not likely to create new ones. Why? Because our brain uses solidified, existing pathways, instead of creating new, unless it is forced to do so.

If the brain is using existing pathways that involve synkinesis, no matter how much you try to force it out, synkinesis will continue, unless you can teach your brain to use different pathways to produce facial expressions.

To understand how this can be done, let’s take a look at how facial expressions are created.

Our facial expressions

You can compare our face to a screen that shows different facial expressions on it. At any given moment, there are two beamers that are projecting onto this screen. These beams are the two different control centres of our brain that dictate which signals are sent to our facial muscles.

One of them is guided by our emotional state. The expressions that we have in this case depends only on the experienced emotions and their intensity. These signals are generated in our limbic system, which is also known as our ‘factory of emotions’. Limbic system has been fine-tuned by the evolution into a universal communication tool. If we are happy, we smile. If we are sad, we frown. Our emotions can dictate our facial expressions, and these signals are mostly sent subconsciously, without our active effort.

The other beamer gets its signals from the motor cortex – our volitional center. With motor cortex, we can consciously control which signals we want to send to our facial muscles, because we want to produce a certain facial expression. If we need to be friendly, we are going to smile, even if we do not feel happy at that moment.

Facial expressions and their control centers
Facial expressions and their control centres

Let’s consider an example: a mother and a child. A child did something very funny, that was not allowed. Internally, the mother is happy and wants to laugh. But she wants to be strict and show her child that what he did, is not good. So the mother starts being angry, saying “Johnny, what are you… hahaha!”, but she bursts into laughter before she can even finish her sentence.

Illustration of control of facial expressions
Illustration of control of facial expressions

This example easily demonstrates that there are always two sources that dictate our facial expressions. Whichever of them is stronger, will be more visible.

Mimetic amplifier after Bell’s palsy

During a long peripheral facial palsy recovery (Bell’s palsy, Ramsay Hunt Syndrome), our motor cortex develops a new habit, which we call a ‘mimetic amplifier’. We explain in our article ‘Is Bell’s palsy permanent?‘, that after your recovery, the signals on the affected side become very strong, even stronger than on the healthy side.

This amplifier is a habit of your brain to constantly increase the intensity of the signals sent from the brain to the facial muscles on the affected side. Its source is in the motor cortex.

These signals are very coarse, but due to the ‘mimetic amplifier’, they are very intense and overlap the signals produced by the limbic system. This makes all imbalances on the affected side more visible.

These intense signals make synkinesis more pronounced, they make facial asymmetry stronger, they make it more difficult to move your mouth corner, they cause painful spasms, etc.

Why facial exercises may increase synkinesis

As explained above, facial exercises are focused on trying to get your brain to make certain movements. Now we know, that if we are consciously trying to move our facial muscles, we use the motor cortex to send signals, as our limbic system is mostly subconscious.

The signals in our motor cortex are being amplified as a side effect of a long peripheral facial palsy recovery. When we follow facial exercises, we use existing pathways that involve this amplification. By constantly repeating these exercises, and we make those pathways even stronger.

So whenever we want to smile, our brain is trained to use those coarse, amplified signals that cause vivid synkinesis, asymmetry and painful spasms.

That is why, in our opinion, the majority of prescribed facial exercises will either have no effect on synkinesis, or may even make it worse.

What exercises can help to reduce synkinesis?

If one wants to reduce synkinesis for long-term, he or she needs to learn to disengage the motor cortex and use signals that come from the limbic system. These signals are a lot more balanced and are not as intense.

To do that, step number one is to stop training your brain by forcing facial expressions. On the contrary, you need to learn to stop using your voluntary center. This involves many different modules, such as working with your emotions, focused facial relaxation, your perception of the self, etc.

This is not an easy task. It involves working not with your facial muscles, but with your brain. That is what we do with our patients in the clinic. We teach them to reduce their mimetic amplifier and make their signals more balanced and less intense. This reduces not only synkinesis, but also other complications and residuals such as facial spasms, excessive tears, chronic pains, facial asymmetry and other.

If you are ready to start working on your condition, or if you have any questions, please contact us.

Alex Pashov

Alex Pashov

Co-founder of Crystal Touch clinic and Bell's palsy expert.

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