Use of Dry Needling to Accelerate Full Recovery in a Patient With Postacute Bell’s Palsy: A Case Report

BACKGROUND: Bell’s palsy is a condition marked by paresis or paralysis of muscle innervated by the facial nerve (cranial nerve VII). The prognosis is good, with spontaneous recovery occurring in 85% of people in 3 weeks. CASE PRESENTATION: A 66-year-old male pastor with Bell’s palsy presented to physical therapy (PT) 3 weeks postonset with right-sided facial drooping. From 3 to 16 weeks, he received standard evidence-based PT interventions. At 6 weeks, electromyography and nerve conduction study data showed presence of satellite and motor unit sprouting indicating signs of probable recovery. At week 14, despite evidenced-based PT interventions, full spontaneous recovery had not occurred and the patient was not satisfied with his function. At this time, the PT plan of care was transferred to a dry needling–certified clinician. At week 16, a 3-week intensive protocol including dry needling and electrical stimulation was implemented. The patient had 2 additional follow-ups with PT treatments and an electromyography at week 27 (8 months) and week 62 (15 months) to assess recovery. OUTCOME AND FOLLOW-UP: House-Brackmann Scale score improved from Grade V at initial evaluation to Grade I at discharge. Patient-Specific Functional Scale score (PSFS) improved from an average of 3/10 at week 14 (pre–dry needling intensive protocol) to 9/10 at week 36 postonset. Nerve conduction onset and amplitude of affected side, measured using the Cadwell Sierra Summit electrodiagnostic system, normalized to the unaffected side at 8 and 15 months, indicating axon remyelination. DISCUSSION: An individualized and intense protocol that included dry needling, combined with electrical stimulation, appeared to have accelerated full recovery in a person with postacute Bell’s palsy who was recovering slowly. JOSPT Cases 2025;5(2):106-117. Epub 25 April 2025. doi:10.2519/josptcases.2025.0068