Complementary Therapies in Medicine 35 (2017) 1–5

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Complementary Therapies in Medicine

journal homepage: www.elsevier.com/locate/ctim

Case report

Acupuncture and Kinesio Taping for the acute management of Bell’s palsy: A MARK
case report
⁎
Derya Özmen Alptekin
Ankara Koru Hospital Physical Medicine and Rehabilitation, Acupuncture Outpatient Clinic Kızılırmak mah., 1450 Sokak No: 13, Çankaya, Ankara, 06510, Turkey

A R T I C L E I N F O A B S T R A C T

Keywords: Background: Bell’s palsy is an idiopathic, acute peripheral palsy of the facial nerve that supplies the muscles of
Bell's palsy facial expression. Despite an expected 70% full recovery rate, up to 30% of patients are left with potentially
Acupuncture disfiguring facial weakness, involuntary movements, or persistent lacrimation. The most frequently used
Kinesio Taping treatment options are corticosteroids and antiviral drugs. However, accompanying clinical conditions, such as
Corticosteroid
uncontrolled diabetes, hypertension, gastrointestinal disturbances, polypharmacy of geriatric patients, and
Physical therapy
significant sequelae ratios, indicate the need for safe and effective complementary therapies that would enhance
Case report
the success of the conventional interventions.
Case summary: A 26-year-old female presented with numbness and earache on the left side of the face; these
symptoms had been ongoing for 8–10 h. Physical examination revealed peripheral facial paralysis of House-
Brackmann grade III and corticosteroid-valacyclovir treatment was initiated. On the same day, Kinesio Taping
was applied to the affected nerve and muscle area with the aim of primarily neurofacilitation and edema-pain
relief. On the fifth day, acupuncture treatment was started and was continued for 3 consecutive days. A physical
therapy program was administered for the subsequent 10 days. At the 3-week follow-up examination, Bell’s palsy
was determined as grade I, and the treatment was stopped.
Conclusion: Acupuncture and Kinesio Taping, in conjunction with physical therapy modalities, are safe and
promising complementary therapies for the acute management of Bell's palsy. However, further large scale and
randomized controlled studies are necessary to assess whether these complementary interventions have sig-
nificant additive or synergistic effect for complete recovery of patients with Bell’s palsy.

1. Introduction for estimating recovery level is the modified House-Brackmann scale.

Bell’s palsy is an idiopathic, acute, peripheral palsy that involves the
facial nerve supplying the muscles of facial expression.1 Bell’s palsy is
responsible for about 80% of all facial mononeuropathies and affects
11–40 individuals per 100,000 each year 2 The cause of Bell’s palsy is
believed to be inflammation of the facial nerve at the geniculate
ganglion, but the cause of the inflammatory process itself remains un-
certain. Increasing evidence implicates a role for the reactivation of
latent herpes viruses from cranial nerve ganglia.1,3
Bell’s palsy typically presents with a sudden and rapid onset of
unilateral facial weakness, often within a few hours. Other symptoms
include impaired ipsilateral movement of the affected side of the face,
drooping of the eyebrow and corner of the mouth, and the loss of the
ipsilateral nasolabial fold. Patients may also complain of ipsilateral
earache, as well as numbness of the face. The most widely used and
accepted clinical tool for documenting the degree of facial paralysis and
The grading is from 1 to 6, with the latter being total paralysis.2
Corticosteroids, antiviral drugs, and physical therapy modalities
(such as electrotherapy, biofeedback, and exercises) are the most fre-
quently used treatment options.2,4,5 Despite some favorable results,
evidence for the efficacy of acupuncture for the treatment of Bell’s palsy
is limited due to the lack of qualified studies.6,7 Kinesio Taping (KT) is
used with other physical agents for the rehabilitation of musculoske-
letal and neurological disorders, as it has positive effects on edema,
neurofacilitation, pain, and functional activities. However, no scientific
data yet supports the efficacy of KT as a treatment for Bell's palsy.8,9
The patient described in the present paper was treated with acu-
puncture and KT in the acute phase of Bell’s palsy, in addition to the
classical therapy methods, and showed an almost total and rapid re-
covery in approximately 3 weeks.

Abbreviations: KT, Kinesio Taping; VAS, Visual analogue scale

⁎
Corresponding author. Present address: Abdurrahmangazi mahallesi, Sevenler caddesi No: 6, Sinpaş Lagün Sitesi DB 12-4, Sancaktepe, İstanbul, 34887, Turkey.
E-mail address: derya.alptekin@hotmail.com.

http://dx.doi.org/10.1016/j.ctim.2017.08.013
Received 1 May 2017; Received in revised form 19 August 2017; Accepted 21 August 2017
Available online 25 August 2017
0965-2299/ © 2017 Elsevier Ltd. All rights reserved.
D.Ö. Alptekin
2. Case presentation
A 26-year-old female patient was referred to the physiatry out-
patient clinic with numbness and discomfort (according to the patient's
expression) on the left side of the face; the symptoms had been ongoing
for 8–10 h. She reported earache at an intensity of 6 on a 10-point vi-
sual analogue pain scale (VAS). She seemed extremely concerned by
this very sudden and unforeseen onset. Her medical history revealed no
systemic illness, such as diabetes or hypertension, and she had no his-
tory of viral or any other infection. The patient was not taking any
medication, had not recently undergone surgery or trauma, and was not
pregnant. During her consultation by a neurologist and an otorhino-
laryngologist, progressive paralysis of mimic muscles was observed
over a period of approximately 1 h. Physical examination revealed
normal external auditory canals and tympanic membranes. The as-
sessment of facial nerve function determined left-sided peripheral facial
paralysis of House-Brackmann grade III, with the following clinical
findings: unable to lift the eyebrow, complete and strong eye closure,
and asymmetrical mouth movement with maximal effort (Fig. 1). Head
and neck examination and all other physical and neurological ex-
amination results were normal. Computed tomography of the brain
revealed normal results and laboratory investigations, including he-
mogram, acute phase reactants, fasting blood sugar, and thyroid func-
tion tests, were all within normal limits.
On the same day, KT was applied, primarily to decompress the
target tissue, redirect edema, and provide pain relief. KT applications
were performed by a physician certified to apply KT, according to the
techniques described by the inventor, Dr. Kenzo Kase.10 A combined
method, based on space correction, functional correction, and neural
techniques, was performed using three I-shaped KT strips, 2.5 cm wide
(Kinesio Tex Gold FP; KT-X-050, Tokyo, Japan). The longer strip was
applied with 25% tension over the preauricular facial nerve area using
the space correction technique, and the ends were applied without
tension towards the temporal and mandibular branches of the facial
nerve. One of the shorter strips was applied with a 50% upward stretch
from the left corner of the mouth, aiming for functional correction. The
other short strip was applied with a 50% stretch along the zygomatic
branch, in accordance with the neural technique (Fig. 2). The tapes
stayed in contact with the skin for two days. This application was re-
peated on the third day and the new tapes remained in place for two
more days.
2
Complementary Therapies in Medicine 35 (2017) 1–5
Fig. 1. On initial evaluation; asymmetrical
mouth movement with maximal effort (left)
and complete and strong eye closure (right).
Pharmacological therapy was initiated on the day of symptom
onset, and a course of oral prednisolone 1 mg/kg/day was administered
for 10 days and oral valacyclovir 400 mg × 5 per day for 5 days.
On the fifth day, acupuncture treatment was started, including the
following points: TE17 (dorsal to the earlobe near to the mastoid pro-
cess), GB14 (above the eyebrow), ST2 (close to the infraorbital
foramen), ST4 (lateral to the corner of the mouth), ST5 (on the front
edge of the masseter muscle) on the affected side, ST36 (lateral to the
anterior crest of the tibia), SP6 (proximal to the medial malleolus), SP9
(distal to the medial condyle of the tibia), and LI4 (in the adductor
pollicis muscle) bilaterally. This treatment was applied on 3 con-
secutive days. The acupuncture needles (0.22 × 13 mm for the acu-
points on the face and 0.25 × 25 mm for the points over the ex-
tremities, Kangnian, China) were left in place for 30 min during each
session. Acupuncture therapy was performed by an experienced and
certified acupuncturist.
On the tenth day, a physical therapy program was started; this in-
cluded electrical stimulation (biphasic surge, pulse time 300 micro-
seconds, frequency 50 Hz, 15 contractions, 5 s rest, total 20 min) and
electromyographic biofeedback (visual and auditory, 10 min/day) for
the facial nerve innervated muscles, as well as mirror exercises. This
program was sustained for 10 days. Pain intensity, as defined by a VAS,
decreased from 6 to 2 in the first 24 h, and the patient was completely
pain free and her anxiety was significantly decreased by the end of the
first week. At the 3-week follow-up examination, Bell’s palsy was de-
termined as House-Brackmann grade I and the treatment was stopped
(Fig. 3). No side effects or unanticipated events were observed in as-
sociation with the treatment methods described. At the 1-month follow-
up examination, the facial weakness had improved, with no sequelae.
3. Discussion
According to the prognosis of Bell’s palsy, although approximately
70% of patients recover spontaneously and completely, 15–20% ex-
perience slight cosmetic sequelae and the remainder are left with
moderate to severe sequelae causing dissatisfaction with the out-
come.1,5 Full recovery rates with early steroid use exceed 90% 5. Facial
muscle dysfunction is a disabling condition and has a dramatic effect on
psychosocial well-being and on quality of life. This emphasizes the
importance of effective and safe treatment options that increase the full
recovery rates without sequelae. The exact etiology of Bell’s palsy
D.Ö. Alptekin
remains uncertain, so treatment modalities primarily focus on reducing
inflammation of the facial nerve.2 The American Academy of Otolar-
yngology recommends a 10-day course of oral corticosteroids, which
should be initiated within 72 h of symptom onset. No evidence thus far
supports a recommendation of oral antiviral therapy alone for the
management of Bell’s palsy. Nevertheless, a corticosteroid-antiviral
combination therapy, administered within 72 h of onset, has been re-
commended by the Academy based on shared decision-making.11
However, oral corticosteroid therapy at such high doses is sometimes a
concern for both the physician and the patients. Comorbid uncontrolled
diabetes, hypertension, gastrointestinal disturbances, or the poly-
pharmacy of geriatric patients indicate the need for safe and effective
complementary therapy modalities that not only enhance the success of
the conventional interventions but also minimize the risk of serious side
effects related to the medications. Moreover, the psychosocial dimen-
sion of Bell’s palsy is often overlooked in the “only medication”
3
Complementary Therapies in Medicine 35 (2017) 1–5
Fig. 2. Kinesio Taping application for left-
sided Bell’s palsy.
therapies, although patients with facial dysfunction suffer from anxiety
as well as depression as a result of facial disfigurement.12 Therefore,
complementary therapy interventions that are capable of not only
physical but also psychological rehabilitation would have more benefit
for patients with Bell’s palsy.
Acupuncture is commonly used to treat a variety of pain and neu-
rological conditions, but evidence is limited in support of its effec-
tiveness for the treatment of Bell's palsy. As yet, the number and quality
of trials have been insufficient to form convincing conclusions.6 The
results of the “Health Consensus Development Conference on Acu-
puncture − 2007,” held by the Society for Acupuncture Research, in-
dicate that the most promising research data on acupuncture for a se-
lected group of neurological conditions are related to Bell’s palsy and
whiplash/neck pain, but acupuncture is not yet a method that can be
definitively recommended in terms of evidence-based medicine.13 More
recently, in 2015, the “Clinical practice guidelines for acupuncture for
Fig. 3. At the 3-week follow-up; symme-
trical mouth movement while whistling and
showing teeth.
D.Ö. Alptekin
Bell’s palsy” were developed by a group of acupuncture practitioners
and researchers, who made the following “Grade A” recommendation:
1. For a treatment course of Bell’s palsy within 3 months, patients with
mild facial palsy may be treated with any one of acupuncture, drugs, or
an acupuncture + drug combination, whereas patients with severe fa-
cial palsy may be treated with acupuncture or an acupuncture + drug
combination. In cases with durations longer than 3 months, acu-
puncture is more suitable. 2. Acupuncture should be applied as early as
possible for Bell’s palsy.14 In the current case, acupuncture therapy was
started on the fifth day of the treatment program, in addition to the
pharmacotherapy, and was continued for three consecutive days.
Similar applications in combination with corticosteroids have been
reported in the literature. For example, a randomized controlled study
by Xu et al. reported that the addition of strong-stimulation acu-
puncture significantly improved the therapeutic effect in patients with
Bell’s palsy treated with prednisone.15 In the current case, the patient’s
total recovery, in as short a period as 3 weeks, suggested that acu-
puncture might have contributed to this outcome. However, the avail-
able parameters are not sufficient to make any definitive interpretation.
Nevertheless, the rising popularity of acupuncture has increased the
number of people, and especially women, seeking this therapy for a
number of clinical conditions, including affective disorders. Acu-
puncture therapy is viewed as safe and effective in treating major de-
pressive disorder and post-stroke depression, according to a recent
systematic review and meta-analysis.16 However, no published research
has yet appeared concerning the effectiveness of acupuncture on co-
morbid depression or anxiety in patients with Bell’s palsy. Conse-
quently, the positive changes in mood and the reduction in anxiety
observed in the current case following each acupuncture session, need
to be confirmed by future well-designed research.
The role of physiotherapy in Bell’s palsy remains contradictory;
however, different physical modalities, such as electrical stimulation,
biofeedback, and exercises, have been used for many years in treatment
protocols. Electrical nerve stimulation and facial retraining (mime
therapy) with biofeedback can enhance functional recovery, but further
studies are needed to assess clinical effectiveness.2,17 Electrical stimu-
lation, biofeedback, and mirror exercises have a psychological benefit,
as the patients observe muscle contraction, which gives them hope for
healing. In the current case, sustaining an intensive physical therapy
program gave rise to clinical improvement and enhanced psychosocial
well-being, through the clinical observations of the rehabilitation team
and according to the patient’s perspective. However, the evidence is too
weak to draw generalized conclusions.
KT, a technique that uses latex-free tape that is structurally similar
to the human skin, is used in conjunction with other physical modalities
in the rehabilitation of some musculoskeletal and neurological condi-
tions. However, no scientific evidence yet supports its efficacy in the
treatment of Bell’s palsy. The inventor of the method, Dr. Kenzo Kase,
proposed that KT exerts its effects by several mechanisms: it decreases
pain by stimulating the neurological system, it restores correct muscle
function by supporting weakened muscles, it reduces congestion of
lymphatic fluid or edema under the skin, and it decreases muscle
spasms.9,10 However, all these mechanisms of action need further
confirmation by randomized controlled studies that include large
number of patients. A detailed literature search revealed case reports of
KT applied to facilitate facial muscles in cases of peripheral facial pa-
ralysis. For example, Whitehead et al. reported a patient with a 2-month
history of Ramsay Hunt Syndrome who was treated with KT in addition
to physical therapy modalities.18 Lizarelli reported a patient who has
been operated for peripheral facial nerve paralysis a month ago and
treated with a combination of KT, photobiomodulation, electrical sti-
mulation, manual massage and facial exercises.19 In these two different
cases, the KT was used to facilitate and/or inhibit facial muscle acti-
vation, and positive outcome measures were reported. However in the
current case, KT was applied using a combination of space correction
(lifting), functional correction, and neural techniques, with primary
4
Complementary Therapies in Medicine 35 (2017) 1–5
aims of edema-pain relief and neurofacilitation in the acute phase of
Bell’s palsy.9,10 Significant pain relief was observed in the first 24 h,
after KT application.
Previous reports also exist in the literature regarding the effects of
KT in relieving pain and edema in other clinical conditions. Homayouni
et al. reported that KT was more effective than naproxen plus physical
therapy for the reduction of pain and swelling in patients with pes
anserinus tendino-bursitis.20 Kalichman et al. applied a similar space
correction technique for meralgia paresthetica symptoms in patients
with lateral femoral cutaneous entrapment neuropathy, and they re-
ported significant pain relief in most of the patients included in the
study.21 Recently, a quite similar application for the treatment of carpal
tunnel syndrome, as another peripheral neuropathy, was reported by
Külcü et al. KT application using a combination of space correction and
the neural technique resulted in significant pain relief and functional
status improvement.22 Despite all these promising results, however, KT
appears to be an intervention that still requires proof of its effectiveness
in future well-designed and controlled studies.
4. Limitations
1. The therapeutic impact of acupuncture, KT, or physical therapy for
the current case cannot be separated from the possibility of spon-
taneous recovery.
2. The lack of standardized protocols regarding KT, acupuncture, and
physical therapy impedes recommendation of the application of
these interventions for patients with Bell’s palsy.
3. The clinical changes were identified by the House Brackmann
grading system, photographic documentation, and the patient’s
subjective reports; however, psychological improvement was not
assessed objectively using an accepted rating scale for depression.
Further studies should evaluate patients with Bell’s palsy from the
perspective of both physical and psychological well-being.
4. The last and most important limitation of the current case was the
inability to differentiate between these interventions (acupuncture
and KT) in terms of their contributions to the complete and rapid
recovery of the patient.
5. Conclusion
Acupuncture and KT, in conjunction with physical therapy mod-
alities, are safe and promising complementary therapies for the acute
management of Bell's palsy. The rapid and complete response of this
case to the treatments indicates the need for large, randomized con-
trolled studies to evaluate the effectiveness and contribution of dif-
ferent complementary interventions, including acupuncture, KT, and
physical therapy, to the conventional treatment of patients with Bell’s
palsy.
Patient perspective
I was very worried because of the sudden weakness on the left side
of my face without any underlying cause. I was also suffering post-
auricular pain. Having visited the physiatry outpatient clinic, I felt
better after I learned that this was not an uncommon situation. I think
that the addition of the acupuncture and Kinesio Taping therapy sup-
ported the positive result of the drug therapy. Especially immediately
after acupuncture sessions, I felt psychologically relaxed. At the end of
the 3-week period of treatment, my face was almost normal. I continued
doing the exercises that were taught to me during the physical therapy
sessions for 2 more weeks. Now, it has been almost a year since this
palsy, and I am totally healthy without any sequelae.
Consent
A copy of the written consent for publication of this case report and
D.Ö. Alptekin
accompanying images is available for review by the Editor-in-Chief of
this journal.
Conflicts of interest
None.
Acknowledgements
None.
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