Guest Blog Post: Rediscovering the Art of the Physical Exam

by Jay Luthar, MD, DipABLM

We are so excited to feature a guest this month: Dr. Jay Luthar from Lutanen Health! In this blog post, Dr. Luthar shares a fresh look at the physical exam — not just as a way to check boxes, but as an opportunity for healing. Let’s see what he has to say about how a more thoughtful, hands-on approach can turn a routine exam into something truly restorative.

Rediscovering the Art of the Physical Exam

In an era of 15-minute visits and checkbox medicine, the hands-on physical exam is becoming a lost art. Many annual physicals are reduced to a brief chat, and a stethoscope tap. I think something is missing here. What if we reclaimed this space, not only for diagnostics, but for healing? 

When I examine a patient, I’m not just palpating abdominal organs for enlargement or pain; I’m feeling their tissue texture, tightness, and observing how it responds to their breath. This can be a window into their stress physiology, diaphragmatic engagement, pelvic floor holding patterns, and interoception. While Physical Therapists, yoga instructors, and bodyworkers spend years dedicated to fine tuning their exteroceptive touch, even the average clinician can attune to some basic principles. I’ve taught these principles to learners at the 2022 Benson Henry Mind Body CME in a Q&A Session, and at the 2025 Cambridge Health Alliance Mind Body Retreat For Residents.

The Modern Physical Exam as Mind-Body Assessment

When palpating the abdomen to assess liver edge or splenic tip, I guide the patient: “Close your eyes and take a deep breath in… and out.” This is more than assessing Murphy’s sign.

While my hands assess the physical findings, my eyes observe nervous system patterns:

• Eye fluttering: often signals sympathetic overactivation.

• Shallow breathing: many patients puff their chests with accessory muscles, rather than engaging the diaphragm.

• Facial and jaw tension: a clenched jaw, lifted eyebrows, and tightened SCMs reflect habitual bracing.

• Disconnected core: a lack of pelvic floor coordination or abdominal expansion reveals blocked breath and likely poor vagal tone.

In just a few breaths, I see the body telling the story the mind has learned to suppress.

Repatterning Breath and Core Function

Rather than simply observe, I use this time to coach. I provide progressive cues:

1. "Soften your jaw and let your tongue rest on the floor of your mouth."

2. "Feel the breath move down into your belly, like a wave of the ocean, in and out."

3. “You are not forcing the air in, you making space for the air to enter you” (quite literally air moves into the thorax through negative intrathoracid pressure difference to atmospheric pressure)

4. "Let your pelvic floor relax open as you inhale, and gently lift as you exhale."

This gentle intervention builds interoceptive awareness, which can enhance emotional regulation and can improve chronic tension and pain.

With our support, the patient begins to recalibrate their breath, body, and brain. This is trauma-informed primary care, somatic medicine available to all clinicians.

Pelvic Floor, Stress, and the Breath

The diaphragm and pelvic floor are biomechanical partners. During healthy breathing, the diaphragm descends with inhalation, and the pelvic floor yields downward in response (Hodges et al., 2007). During exhalation, both recoil upward.

But stress flips this equation.

• Chronic sympathetic tone elevates the diaphragm, shortens breath cycles, and locks the pelvic floor.

• Overuse of accessory muscles (scalenes, upper traps, intercostals) reflects poor breathing mechanics and chronic tension. Improving breathing efficiency is beneficial for everyone, particularly performance athletes. 

• This uncoupling of breath and pelvic floor is a root cause of incontinence, pelvic pain, and hypertonicity.

Studies in pelvic floor PT confirm that breath retraining improves pelvic floor coordination, tone, and pain.

Mind-Body Medicine: Science and Tradition

From a mind-body science, breath is a diagnostic tool and a treatment. Modern science now explains what healing traditions from antiquity have observed.

• Controlled breathing modulates vagal tone, reduces cortisol, and shifts the nervous system from fight-or-flight to rest-and-digest.

• Somatic therapies like breathwork, body scans, and movement-based mindfulness have shown reductions in pelvic floor tension, pain, and trauma symptoms 

• Improving Autonomic Nervous System overactivation and entering a relaxation response state is directly anti-inflammatory. Research is linking inflammatory and stress conditions and potential drivers of cardiovascular, metabolic, immune, and neurocognitive disease.

Bringing This Into Every Exam Room

It only takes 3–5 minutes. But it builds therapeutic alliance, enhances diagnostic depth, and helps patients reconnect with the most ancient medicine they have: their own breath. What if the annual physical wasn’t just a routine screening, but a window into the nervous system and a reset for the body-mind? We can return to hands-on care. We can use breath and palpation as portals. We can treat not just dysfunction, but disconnection.

Suggested References

• Hodges, P. W., Sapsford, R., & Pengel, L. H. M. (2007). Postural and respiratory functions of the pelvic floor muscles. Neurourology and Urodynamics, 26(3), 362–371.

• Resende, A. P. M., et al. (2021). Effect of diaphragmatic breathing on the pelvic floor muscle function. Neurourology and Urodynamics, 40(6), 1463–1470.

• Mehling, W. E., et al. (2012). Body awareness: a phenomenological inquiry into the common ground of mind-body therapies. Philosophy, Ethics, and Humanities in Medicine, 7(1), 6.

• van der Kolk, B. (2014). The Body Keeps the Score. Viking.

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Jay Luthar, MD, DipABLM is a Harvard-trained internal medicine physician who blends evidence-based primary care with integrative approaches. Learn more at jaylutharmd.com or lutanen.com.