Synkinesis Advice

What is synkinesis?

Synkinesis (pronounced sink-eye-nee-sis) means the development of linked or unwanted facial movements.
It is common and occurs in the majority of people who are recovering from prolonged facial palsy.

What does synkinesis look and feel like?

  • Only the affected side of the face develops synkinesis.
  • The areas that are normally most affected are the eye, cheek, chin and neck.
  • Synkinesis may show itself in various ways. The following are some examples of how synkinesis looks and feels. Remember, synkinesis occurs on the affected side and can be more clearly observed when compared to the unaffected side:
    • You may notice your eye narrows when you smile.
    • Your cheek lifts when you close your eyes.
    • You may notice your neck muscle tightens when you try to whistle.
    • Facial twitching, especially in the cheek and sometimes the chin, is also a form of synkinesis.
    • Facial muscles, including those across your brow, may become tight, causing facial pain and occasionally headaches.
    • Some people find when they eat their eye waters or their nose streams.
    • Commonly, when relaxed, the affected side of the face may have a deeper cheek crease, the cheek may appear bulky, the eye narrow or the mouth pulled up.

Muscles are mistakenly thought of as weak when actually they are tight or stiff and find it difficult to move.

What are the symptoms?

  • High tone in your facial muscles: This means that even though the facial muscles on the affected side of your face feel relaxed when you are resting, they are often actually working more than the good side. When you try to move they can work twice or three times harder than the good side.
  • Short, tight muscles: Facial muscles can become short and tight because they are overworking all the time. The overworked muscles become short and stiff which makes them difficult to move when you want to express yourself.
  • Linked movements: The recovering facial nerve is poorly insulated, resulting in messages to move one particular muscle being picked up by another muscle. The effect of this is more than one muscle moving at the same time (for example, when you smile, your eye closes). Over time these linked movements become a habit and although the nerve recovers, the habitual movements remain.
  • Reduced coordination: After any injury it is hard to coordinate movements and muscles properly as you recover. Muscles tend to all work together rather than doing their specific job.
  • Poor movement sequencing: After injury your body tends to forget which bits of movement should happen first so it all happens as one ‘bulk’ movement which doesn’t look natural. Sometimes the wrong muscles can work which pull against the right muscles in a ‘tug of war’. This means that no movement can happen as the muscles are cancelling each other out.
  • Dominant movements: The ‘uninjured side’ of your face or the wrong muscles are ‘stronger’ in the tug of war so they take over. The movement you are actually trying to do is overshadowed by these stronger ones and can’t be seen.

What can you do to improve your synkinesis?

  • Ask your GP or doctor to refer you to a speech and language therapist or physiotherapist who has specialist knowledge in facial rehabilitation. You may need to identify your nearest specialist service in order to obtain the correct treatment.
  • Your therapist will teach you what synkinesis is and why it happens.
  • You will also learn to identify which muscles normally work during movements and therefore which additional muscles are working during your synkinetic movement.
  • Avoid going to other sources for help as synkinesis can be made worse if exercises are carried out incorrectly.
  • You will require a bespoke home exercise programme which will meet your individual needs.
  • In some cases it may be appropriate to have treatment with Botulinum toxin injections. These can be used to reduce the over activity of synkinetic muscles and rebalance facial movements.

Question: Can facial therapy alone reverse synkinesis?

Answer: If treated early enough, in some cases synkinesis can be resolved. In long-term cases, regular soft tissue release and stretches will temporarily make the face feel less tight however the tightness does return. The stretches do however form the foundation for facial movement retraining. When this is practised long term it helps to reduce the unwanted movements and improve symmetry of facial expression. Your facial exercise programme should always be guided by a specialist facial therapist.

Self-help videos

See our self-help videos for managing tightness due to synkinesis. Please note this is a series of 4 short videos in one.

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Last reviewed: 08-06-2020    ||    Next review due: 08-06-2024