Introduction
Bell’s palsy is one of the most common causes of acute unilateral facial paralysis, accounting for approximately 60-75% of cases.1 It is traditionally managed with early corticosteroids, supportive therapies, and careful monitoring for red flags. Although most patients recover within 6 months, up to 1/3 experience residual weakness or facial dysfunction that persists beyond the expected healing timeline.1 This variability in recovery has led to increasing interest in adjunctive rehabilitative interventions such as photobiomodulation (low-level laser therapy or LLLT), neuromuscular retraining, and manual therapy to support facial nerve healing when standard medical management is insufficient.2 Despite these emerging options, high-quality evidence for many conservative approaches remains limited, and treatment pathways lack consistency in the current literature.
The postpartum population represents a unique subset of Bell’s palsy patients. These individuals can develop facial paralysis during late pregnancy, or shortly after delivery, and tend to have worse outcomes compared to non-pregnant patients.3,4 These patients are also less likely to receive timely corticosteroid therapy, further contributing to poorer prognosis.3,4 Given these challenges, and the rapid physiologic changes that occur during the postpartum period, there is a significant need to document cases that explore alternative and adjunctive approaches when initial medical therapy fails to produce full recovery.
Although current literature exists supporting the use of photobiomodulation and rehabilitative therapies for Bell’s palsy, evidence for chiropractic management, particularly upper cervical-specific chiropractic care, is sparse and limited primarily to isolated case reports.1–5 Additionally, no published cases describe a multimodal treatment approach combining upper cervical correction, LLLT, and facial neuromuscular exercises in a postpartum patient with incomplete recovery after standard pharmaceutical treatment. Given the potential role of the upper cervical spine interaction with cranial nerves utilized in facial pain and facial nerve dysfunction, positive responses occurred in chiropractic case studies involving facial palsy with concurrent neck symptoms.5 This combined approach warrants further exploration in future studies.
Our paper describes a postpartum patient who developed Bell’s palsy 4 days after delivering her child and experienced incomplete recovery despite early corticosteroids and antivirals. She sought care 2.5 months later with persistent unilateral facial weakness, asymmetry, and sensory changes.
This report highlights the patient’s response to a multimodal treatment plan incorporating upper cervical Grostic technique adjustments, LLLT, and facial neuromuscular retraining, contributing new insight into conservative care options for delayed-recovery postpartum Bell’s palsy. Grostic technique is a precise, low-force chiropractic technique focusing exclusively on the upper cervical spine and using meticulous X-ray analysis to determine exact angles of correction. This paper also addresses a major gap in the literature by describing an approach that integrates evidence-supported modalities of LLLT and facial rehabilitation, with an understudied intervention of upper cervical specific chiropractic care.
Case Report
Patient Demographics and Chief Complaint
A 32-year-old postpartum female sought care for persistent right-sided facial paralysis consistent with Bell’s palsy. Secondary concerns included chronic cervical stiffness and neck pain, and she expressed interest in full-spine wellness care.
History of Present Illness
She experienced a sudden onset of right-sided facial paralysis 4 days after giving birth. No CT imaging was performed at the time. She completed courses of corticosteroids and antiviral medication with no improvement. Although referred to a neurologist, she had not scheduled a visit, preferring to pursue conservative care first. She came to the clinic approximately 2.5 months after symptom onset due to persistent functional limitations and cosmetic concerns.
Her facial paralysis was constant, with intermittent stabbing or piercing pain occurring twice weekly, lasting several minutes, and rated 4/10 at worst. The pain lacked clear aggravating or relieving factors. She reported difficulty with activities of daily living, especially sleeping, and increased self-consciousness regarding her appearance.
She also described chronic neck stiffness and achy pain originating from a 2018 motor vehicle collision, with partial relief from previous physical therapy and medications. Since the onset of Bell’s palsy, she noted increased neck stiffness and episodic neck pain coincided with facial discomfort. Cervical pain was aggravated by flexion, extension, and prolonged sitting and relieved by general range of motion stretching and heat.
Past Medical, Social, and Lifestyle History
She reported no significant medical history aside from her prior motor vehicle accident. She denied tobacco, alcohol, and drug use, engaged in light exercise, and maintained a balanced diet. She slept 6-8 hours per night, consistent with her postpartum stage. Her pregnancy and delivery were uncomplicated and represented the only relevant lifestyle factor associated with increased risk of Bell’s palsy. No additional social or lifestyle elements were identified that would affect her recovery.
Examination Findings
Observation revealed marked right-sided facial paralysis with normal cervical posture. She had decreased facial sensation on the right, complete inability to perform right-sided facial expressions, impaired accommodation of the right eye, and reduced TMJ motion on the right. Cervical active range of motion was decreased in flexion, extension, right lateral flexion, and rotation, with pain at the base of the skull. Palpation revealed bilateral suboccipital and cervical paraspinal hypertonicity. Her vital signs were Temp: 98 F, HR: 89 /min, BP: 110/70 mm Hg, RR: 14 /min, Ht: 61 in, Wt: 157 lbs.
Diagnostics and Imaging
Cervical spine radiographs were obtained, including lateral, anterior–posterior lower cervical (APLC), anterior–posterior open mouth (APOM), nasium, and vertex views. These studies were ordered to evaluate global and segmental cervical alignment, assess for structural changes related to the patient’s 2018 motor vehicle collision, and identify biomechanical factors potentially contributing to her chronic neck pain and persistent facial weakness. Upper cervical views were specifically taken to analyze atlas position relative to the skull and the lower cervical spine, which is essential for upper cervical–specific chiropractic analysis.
Assessment and Diagnosis
Based on the patient’s history, symptom chronology, and examination findings, she was diagnosed with Bell’s palsy with persistent motor and sensory deficits approximately 2.5 months postpartum. Her presentation was characterized by complete right-sided facial paralysis, loss of facial sensation, impaired jaw mechanics, and inability to perform cranial nerve VII motor functions on the right. These findings were consistent with chronic or unresolved Bell’s palsy rather than an acute neurologic event.
Contributing musculoskeletal factors included chronic neck pain due to mild disc degeneration at the C5-C6 level, with associated hypertonicity of the suboccipital and paraspinal musculature. These cervical findings may have contributed to altered neuromuscular discomfort, especially during episodes of facial pain.
Management and Intervention
The patient was managed using a multimodal approach consisting of upper cervical specific chiropractic adjustments, LLLT, and a structured facial neuromuscular retraining program. Appointments were scheduled twice weekly to evaluate whether an upper cervical adjustment was indicated. LLLT was introduced after initial improvement in facial pain and continued during subsequent visits. Each visit began with a standardized assessment consisting of Tytron thermal scanning, opponens strength testing, motion palpation, supine leg-length evaluation, and focused cranial nerve testing. An adjustment was considered indicated when 2 or more findings demonstrated loss of atlas alignment compared with the patient’s established baseline measurements.
When findings indicated a loss of atlas alignment, an upper cervical adjustment using the Grostic technique was performed; when alignment was maintained, no manipulation was given. Regardless of alignment status, LLLT was applied to the right facial region each visit, targeting the frontalis, buccinator, zygomaticus, masseter, and temporalis muscles at 1.2 J/cm2 for 8 minutes to support facial neuromuscular recovery.
We also recommended bilateral facial neuromuscular retraining exercises to be completed 3x daily in front of a mirror. Additional recommendations included maintaining hydration, establishing consistent sleep routines, incorporating daily walking, and avoiding cervical positions that could increase strain, especially ensuring a neutral neck position during sleep.
She received care for 6 weeks, attending twice-weekly visits. After her first upper cervical adjustment using the Grostic technique was delivered, she reported complete resolution of her chronic neck pain, with no recurrence for the remainder of care. Within 3 weeks she began noticing early return of facial function, including partial activation of her right-sided smile.
LLLT and facial neuromuscular retraining were incorporated after initial improvement in facial pain, as initiating these interventions earlier may have limited her ability to tolerate active facial muscle engagement. Following the addition of these interventions, she demonstrated progressive increases in voluntary right-sided facial muscle activity, improved symmetry when smiling, and fewer episodes of intermittent sharp facial pain.
Throughout her course of care, atlas alignment was monitored at every visit; adjustments were delivered only when pre-adjustment indicators showed loss of correction, while several visits demonstrated stable alignment requiring no manipulation. A single full-spine treatment was performed during the course of care to address secondary segmental findings at C2, T4, and the sacrum. Her primary care plan focused on upper cervical-specific chiropractic care, which she explicitly requested due to her goals of low-force, precise management for her Bell’s palsy and cervical complaints. On this visit, the patient reported an isolated episode of thoracic and lumbosacral discomfort unrelated to her primary facial or cervical symptoms. In response, a limited full-spine intervention was provided to address these localized findings, after which she elected to continue exclusively with upper cervical focused care for the remainder of her treatment plan.
Within 4 weeks, both the patient and people close to her noted significant improvements in facial function, including better eye closure, eyebrow elevation, and increased visibility of her teeth while smiling. Although she reported occasional periods where progress felt slower, her functional gains continued steadily through her final visit. She tolerated all interventions well, demonstrated high compliance with her home exercise program, and experienced consistent improvement across both cervical and facial outcomes. A clinical timeline of care is presented in Table 1.
Clinical Course and Outcomes
Table 1 details her visit calendar. Neck pain resolved following early upper cervical care and did not recur. Progressive facial motor improvements were noted after the introduction of laser therapy and facial exercises, including improved smile symmetry, eye closure, and reduced facial pain. All interventions were well tolerated with high compliance.
Discussion
This paper describes a postpartum patient with persistent right-sided Bell’s palsy who experienced meaningful improvement in facial motor function, symmetry, and episodic facial pain following a multimodal conservative treatment plan that included upper cervical specific chiropractic adjustments (Grostic technique), LLLT, and facial neuromuscular retraining. Her recovery occurred more than 2 months after symptom onset, well beyond the typical early recovery window, after corticosteroids and antivirals had failed to produce change. Notably, facial activation began to return within weeks of initiating care, and her chronic cervical discomfort resolved early and remained absent throughout treatment.
The patient’s presentation and progression align with medical literature showing that up to 1/3rd of Bell’s palsy cases experience prolonged deficits or incomplete recovery, especially in postpartum individuals who often have worse outcomes. Evidence on LLLT supports its role in improving facial nerve severity, asymmetry, and neuromuscular activation, consistent with the improvements seen once laser therapy was incorporated.6 Similarly, previous reports demonstrate that facial neuromuscular retraining can facilitate improved symmetry and facial control in chronic cases. While chiropractic literature on Bell’s palsy is limited, prior case reports describe improvement in facial nerve symptoms when cervical dysfunction, particularly upper cervical involvement, is addressed.5 This case adds to that small body of work by using a precise, low-force upper cervical method rather than general manipulation, suggesting a potential biomechanical or neuromuscular influence worth further study.
For chiropractors, this case, and concurrent research, highlights the value of a multimodal conservative approach for patients with subacute or persistent Bell’s palsy who have not responded to initial medical treatment.7 LLLT appears to be a safe and potentially effective adjunct for enhancing facial nerve recovery, and facial neuromuscular retraining may support improved symmetry and motor control. Additionally, this case illustrates the importance of considering upper cervical specific assessments, especially in patients with concurrent neck symptoms or a history of trauma as biomechanical dysfunction in this region may influence neuromuscular pathways associated with facial movement. While not a substitute for medical evaluation, these interventions may offer meaningful functional improvements and serve as supportive care in multidisciplinary management.
Ethics and Limitations
The patient provided informed consent for chiropractic care and for the use of her de-identified clinical information in this report. All patient details were redacted to protect privacy and confidentiality in accordance with ethical standards for case reporting. Care was delivered within the scope of chiropractic practice, and the patient was encouraged to pursue neurological consultation as originally recommended. The risks, benefits, and alternatives to care were explained prior to treatment, and all interventions used were conservative and non-invasive. No adverse events were reported throughout the course of care. This case report has several limitations. As a single-patient case, the findings cannot be generalized and do not establish causation. The multimodal nature of the treatment plan including upper-cervical chiropractic care, low-level laser therapy, and facial neuromuscular retraining makes it difficult to determine which intervention contributed most to the patient’s improvement. Due to the variable nature of Bell’s Palsy, spontaneous recovery cannot be completely ruled out. Long-term follow-up beyond the treatment period was not available, limiting assessment of sustained outcomes. Despite these limitations, this case contributes to the limited literature on conservative management options for persistent Bell’s palsy, particularly in postpartum patients.
Conclusion
Due to the patient’s Bell’s Palsy lasting longer than the typical 3 to 8 weeks of spontaneous recovery, outlined in current research along with utilization and exhaustion of traditional treatments of corticosteroids and antivirals; this case does not fall into the conventional time frame of Bell’s Palsy. This case illustrates that patients with persistent Bell’s palsy, particularly postpartum individuals who have not responded to standard medical therapy, may benefit from a multimodal conservative approach that includes upper cervical assessment, low-level laser therapy, and facial neuromuscular retraining. The patient demonstrated meaningful functional recovery after several weeks of care, despite presenting outside the typical early recovery window. Although conclusions cannot be generalized from a single case, this report contributes to the limited literature on chiropractic involvement in facial nerve disorders and suggests that targeted, low-force upper cervical methods may play a supportive role in managing unresolved Bell’s palsy. Clinicians should consider the cervical spine, neuromuscular function, and adjunctive therapies as part of a comprehensive evaluation when treating patients with prolonged facial paralysis.