Bell’s palsy is a sudden weakness or paralysis of the muscles on one side of the face, caused by dysfunction of the facial nerve (cranial nerve VII). For most people, it resolves on its own within months. For a meaningful minority, it does not. A new case report in the Journal of Contemporary Chiropractic describes one of those people: a 32-year-old woman whose facial paralysis began four days after giving birth and had not improved after standard medical treatment.
The new case report, titled “Upper Cervical Chiropractic Care and Photobiomodulation in Postpartum Bell’s Palsy: A Case Report with Review of Current Evidence”, reports progressive improvement in facial function over six weeks of combined care: upper cervical-specific chiropractic adjustment, low-level laser therapy to the facial muscles, and home facial retraining exercises.
While we cannot make generalisations based on single case reports, and larger chiropractic studies on this phenomenon have not yet been done, there is something that makes this paper notable: this is not a common phenomenon, yet this case report is the tenth chiropractic case report on the issue.
The condition
Bell’s palsy is the most common cause of one-sided facial paralysis. It typically comes on over a day or two, and its features are recognisable: inability to close the eye fully, a drooping corner of the mouth, loss of forehead wrinkling, flattening of the fold between nose and mouth, and difficulty eating and drinking. It is a diagnosis of exclusion, with practitioners looking to rule our stroke, tumour, Lyme disease, Ramsay Hunt syndrome and other causes before landing on “well it must be Bell’s palsy then.”
Standard medical care is corticosteroids, sometimes with antivirals, ideally started early. A recent review in Cureussummarises the natural history simply: most patients recover fully within six months regardless of treatment. However, it is very much a case of “most” not “all”. The source paper notes that up to one-third of cases experience prolonged deficits or incomplete recovery, and that postpartum individuals often have worse outcomes. Pregnancy (particularly the third trimester and the early postpartum period) is widely recognised as a period of increased risk. Persistent Bell’s palsy can be distressing as it affects eating, speaking, eye protection, and a person’s ability to express emotion with their own face, at a time when a new parent is already stretched.
The case
The topic of the case report was a 32-year-old woman whose right-sided facial paralysis began four days after she gave birth. She had been treated with corticosteroids and antivirals, without improvement. When she presented for chiropractic care two and a half months after onset, she reported a complete inability to make right-sided facial expressions, intermittent stabbing facial pain (around twice a week, rated 4/10), reduced sensation on the right side of her face, and difficulty with right eye accommodation.
But chiropractic care is not directed at isolated symptoms. It takes in a person’s whole picture of health and cares for the whole person. This patient brought a longer history with her which included a motor vehicle collision in 2018 that left her with chronic neck stiffness and pain.
Examination found marked right-sided facial paralysis consistent with facial nerve motor deficits, reduced right temporomandibular joint (TMJ) motion, hypertonicity of the suboccipital and cervical paraspinal muscles on both sides, and reduced cervical range of motion in every direction tested. Radiographs (including upper cervical views taken to analyse atlas position relative to the skull and lower cervical spine) showed degeneration at C5–C6 and upper cervical misalignment on radiographic analysis.
Care was delivered twice weekly over six weeks and had three components.
Upper cervical-specific adjustments were delivered using the Grostic technique – this is a low-force, atlas-specific method. Atlas alignment was assessed at every visit using thermal scanning, motion palpation and supine leg-length evaluation, and an adjustment was delivered only when those pre-adjustment indicators showed loss of correction. Several visits required no adjustment at all.
Photobiomodulation, also called low-level laser therapy (LLLT) or cold laser, was also deployed as part of her care. This uses low-intensity light to influence cellular activity in tissue. Here it was applied to the right side of the face at each visit, targeting the frontalis, buccinator, zygomaticus, masseter and temporalis muscles, at 1.2 J/cm² for eight minutes.
Facial neuromuscular retraining was used at home in order to reinforce the effects of care.
The laser and exercises were not started at the first visit. The authors deliberately introduced them at the fifth visit, after her facial pain had begun to settle, reasoning that she may not have tolerated active facial muscle work earlier. The first four visits were upper cervical care alone.
Notably, the results started to emerge early on in care. After her first upper cervical adjustment, she reported complete resolution of her chronic neck pain — pain she had carried since 2018 (more than five years). It did not return for the remainder of care. This, on its own, was significant.
Facial change came more gradually. By the fourth visit (still before laser or exercises had been introduced), she noticed an early return of her smile. From the sixth visit, increased facial muscle contraction was observed, and improvement continued through to her final visit. Within four weeks, both she and people close to her noticed better eye closure, better eyebrow elevation, and more of her teeth showing when she smiled. Her episodic facial pain reduced. No adverse effects were reported, and she kept up her home exercises consistently.
The authors frame their conclusion carefully: patients with persistent Bell’s palsy, particularly postpartum individuals who have not responded to standard medical therapy, may benefit from a multimodal conservative approach including upper cervical assessment, laser therapy and facial retraining. She was in this cohort, as she commenced care some weeks after birth, and after the onset of symptoms.
We cannot tell what would have happened had chiropractic not been introduced. However, it is reasonable to assume (given the longevity of her symptoms and the fact they hadn’t improved with traditional medical care), that she may have been in the unlucky category that did not fully resolve.
What the wider chiropractic literature says
A search of the Index to Chiropractic Literature, supplemented by PubMed, turns up a small but persistent body of chiropractic case reports on Bell’s palsy — ten peer-reviewed reports (including this one) describing thirteen patients, published between 1992 and 2026. Read together, they fall into recognisable threads.
- The early reports: adjustment plus electrotherapy. In 1992, Frach, Osterbauer and Fuhr described two patients treated with mechanical-force, manually assisted adjusting (Activator Methods) combined with high-voltage electrotherapy, noting at the time that no chiropractic report on Bell’s palsy had yet appeared in the literature. They offered their cases explicitly as a “baseline” for future comparison. The following year, another report covered the cases of two adolescents (aged 15 and 17), both graded House-Brackmann V, treated with high-voltage galvanic stimulation and cervical manipulation; symptoms resolved in six and three weeks, respectively. Both began care within days of onset (exactly when natural recovery is most likely), which limits what those outcomes can tell us.
- Full-spine and diversified care in longer-standing cases. In 2003, Alcantara and colleagues published on a 49-year-old woman with facial paralysis, TMJ pain, neck pain and marked sound sensitivity, cared for with Gonstead adjustments to spinal, occipital and TMJ sites over six months, with continued improvement. A 2011 case report described a 47-year-old woman with chronic Bell’s palsy who received cervical and thoracic adjustments with muscle stimulation, improving from the first visit and reaching 90% improvement after a year of care.
- Upper cervical care. A 2013 paper described a 53-year-old man with residual symptoms two years after onset, treated with occiput–C1 adjustments, myofascial release, home facial exercises and acupuncture; he was almost symptom-free after three months. This was followed by a 2019 paper reporting on a 68-year-old man two weeks into a Bell’s palsy episode, unresponsive to steroids, who received NUCCA upper cervical care; his face was reported as 80–90% improved by the third visit and his paralysis resolved after four visits.
- Chiropractic plus Photobiomodulation. This case report isn’t the first to cover chiropractic with cold laser therapy for Bell’s palsy. In 2013, a case report described a 40-year-old man ten days into an acute episode, treated with a 910 nm laser along the course of the facial nerve plus chiropractic care. He reported 70–80% improvement after the first treatment and full control of his facial movements after the second. In 2014, another pair of chiropractors used monochromatic infrared energy (890 nm) in two patients: an acute case reported 95% improvement after six weeks, while a chronic case (incompletely recovered after eighteen months of steroids and electro-acupuncture) reported 50% improvement over nine months.
- The facial pain connection. The most useful recent contribution is from Chu, Trager and Chen (2022). They reported a 52-year-old woman whose recovery had plateaued at 60% after three years, with concurrent facial pain, facial numbness and neck pain. Following multimodal chiropractic care, her facial paresis and pain resolved at one-month follow-up, apart from some residual eyelid synkinesis. More importantly, they reviewed the published chiropractic literature and identified twelve additional cases in which chiropractic with multimodal care was reported to improve Bell’s palsy. Across those cases, 85% of patients also had pain in the face or neck. They proposed that the trigeminal pathway may be involved in why these particular patients seem to respond.
That observation sits well alongside the new case. This practice member, too, had facial pain, facial sensory loss and long-standing neck pain. Her neck pain resolved immediately with upper cervical care, and her facial pain reduced over the course of care.
What this means for chiropractic
This literature raises an interesting question: do people with persistent Bell’s palsy, particularly those who also have facial or neck pain, improve when upper cervical or spinal care is added to their management?
From a chiropractic perspective, the interest lies in the relationship between upper cervical function and the nervous system. The ASRF defines vertebral subluxation as “a diminished state of being, comprising a state of reduced coherence, altered biomechanical function, altered neurological function and altered adaptability.” The close anatomical and neurological relationship between the upper cervical spine, the brainstem and the trigeminal system offers a plausible reason to explore whether addressing upper cervical dysfunction may play a role in some cases.
The persistent group is where research effort is best directed. It is the group for whom natural recovery is least likely to explain improvement, the group with the fewest effective options, and — as the Dunwoodie case reminds us — a group that includes new parents at a vulnerable time.
An important note for patients reading this: sudden facial weakness always needs prompt emergency medical assessment, because it can be a sign of stroke or other serious conditions, and early medical treatment for Bell’s palsy matters. Every practice member described in these reports had a medical diagnosis, and chiropractic care was part of their management rather than a replacement for it.
This case report, and the thirty-odd years of observations behind it, point toward something we should examine further. That is, preliminary case report data suggests that some people with persistent Bell’s palsy, particularly those with accompanying facial or neck pain, may respond to care that includes the upper cervical spine. Turning that suggestion into evidence requires properly designed studies, and those studies need funding. The practitioners who took the time to write up these cases have laid the groundwork; the next step belongs to the profession as a whole.
If you would like to support research that turns clinical observations like these into rigorous studies, you can donate to the Australian Spinal Research Foundation here.
Reference
Dunwoodie J, Merrill K, Booz D. Upper cervical chiropractic care and photobiomodulation in postpartum Bell’s palsy: A case report with review of current evidence. *J Contemp Chiropr.* 2026;9(1):402–407. https://journal.parker.edu/article/170272
Further reading
– Alcantara J, Plaugher G, Van Wyngarden DL. Chiropractic care of a patient with vertebral subluxation and Bell’s palsy. *J Manipulative Physiol Ther.* 2003;26(4):253. doi:10.1016/s0161-4754(02)54112-9
– Chu EC, Trager RJ, Chen AT. Concurrent Bell’s palsy and facial pain improving with multimodal chiropractic therapy: A case report and literature review. *Am J Case Rep.* 2022;23:e937511. doi:10.12659/AJCR.937511
– Cotton BA. Chiropractic care of a 47-year-old woman with chronic Bell’s palsy: A case study. *J Chiropr Med.* 2011;10(4):288–293.
– Frach JP, Osterbauer PJ, Fuhr AW. Treatment of Bell’s palsy by mechanical force, manually assisted chiropractic adjusting and high-voltage electrotherapy. *J Manipulative Physiol Ther.* 1992;15(9):596–598.
– Gardner S, Garber L, Grossi J. Bell’s palsy: Description, diagnosis, and current management. *Cureus.* 2025;17(1):e77656. doi:10.7759/cureus.77656
– Lin HW, Chen HC, Lin LF, Tam KW, Kuan YC. Laser therapy for Bell’s palsy: A systematic review and meta-analysis of randomized trials. *Lasers Med Sci.* 2024;39(1):282. doi:10.1007/s10103-024-04237-2
– Ng SY, Chu MHE. Treatment of Bell’s palsy using monochromatic infrared energy: A report of 2 cases. *J Chiropr Med.* 2014;13(2):96–103. doi:10.1016/j.jcm.2014.06.010
– Nguyen A, Rose K, Hwang S. Integrated chiropractic and acupuncture treatment for a patient with persistent symptoms of Bell’s palsy: A case report. *Top Integr Health Care.* 2013;4(3).
– Preece S, Alcantara J. Resolution of Bell’s palsy in a 69-year-old man following correction of upper cervical subluxation: A case report and review. *J Upper Cervical Chiropr Res.* 2019 Apr:28–35.
– Rubis LM. Chiropractic management of Bell palsy with low level laser and manipulation: A case report. *J Chiropr Med.* 2013;12(4):288–291.
– Shrode LW. Treatment of facial muscles affected by Bell’s palsy with high-voltage electrical muscle stimulation. *J Manipulative Physiol Ther.* 1993;16(5):347–352.
