What We Learned Evaluating the Plano, TX Chiropractic Market

By David Main, DC — Founder, EasyDocForms

I recently pulled Semrush data on three chiropractic practices competing in the same Plano, TX market. Same city, same patient pool, roughly the same domain authority scores. What I found challenges everything the SEO agencies are selling you.

The Setup: Three Practices, One Market

Quick answer: Three practices within miles of each other, domain authority 8–10, all using review automation. Same hand, wildly different results.

All three practices operate within miles of each other. Their domain authority scores are nearly identical—between 8 and 10 on a 100-point scale. They all use review automation software. They all have Google Business Profiles. They're playing with the same hand.

But their results couldn't be more different.

Metric	Practice A	Practice B	Practice C
Organic visitors/month	748	697	74
Keywords ranking	176	634	68
Referring domains	82	149	147
Backlinks	554	326	885
Domain authority	10	10	8

Read that again. Practice C has the most backlinks—885—and gets the least traffic. Practice A has roughly half the backlinks of Practice C and gets 10x the traffic. Practice B has the fewest backlinks of the bunch and ranks for 3.6x more keywords than Practice A.

If you're paying an agency $2,000 a month to build backlinks, this should make you uncomfortable.

Backlinks Didn't Win

Quick answer: Practice C has the most backlinks (885) and the least traffic (74 visitors/month). In local markets where every practice has domain authority between 8–10, backlinks are table stakes, not a differentiator.

For years, the SEO playbook for chiropractic practices has been dominated by link building. Agencies sell packages promising 20, 50, 100 backlinks per month. The theory is simple: more links pointing to your site equals more authority equals higher rankings.

Practice C is living proof that this theory is broken—or at least incomplete. They have the most backlinks in this market by a wide margin, yet they rank for the fewest keywords and pull the least traffic. The links aren't translating into visibility.

Why? Because Google's algorithm has evolved. Links still matter as a baseline signal, but they've been demoted relative to content relevance, user experience signals, and what Google now calls E-E-A-T: Experience, Expertise, Authoritativeness, and Trustworthiness.

When every chiropractor in a market has roughly the same domain authority—and in local markets, they almost always do—backlinks become a wash. They're table stakes, not a differentiator.

Reviews Cancelled Each Other Out

Quick answer: Every competitive practice in Plano uses the same CRM-driven review automation. When everyone has 200+ reviews at 4.8 stars, reviews stop being a competitive advantage. They're the cost of entry.

Here's another finding that surprised me. Both Practice A and Practice C use the same type of CRM-driven review automation tool. After every visit, patients get a text or email prompting them to leave a Google review. Both practices have strong review profiles.

When I looked at the broader market, this pattern held up. Nearly every competitive chiropractic practice in Plano is using some variation of the same automated review funnel—whether it's ReviewWave, Aloha, BirdEye, or something similar.

This means reviews have become another baseline. When everyone has 200+ Google reviews at 4.8 stars, the reviews stop being a competitive advantage. They're the cost of entry. The patient doesn't choose you because you have 312 reviews instead of 287.

So if backlinks are neutralized and reviews are neutralized, what's actually driving the difference?

Content Is the Only Lever Left

Quick answer: Practice A built dedicated landing pages for every condition and treatment with real clinical substance, embedded Google reviews on condition pages, displayed insurance logos with geo-targeted alt text, and ran separate domains per location. 176 high-intent keywords, 748 visitors/month.

Practice A—the one getting 748 visitors from only 176 keywords—does something the others don't. They built a dedicated landing page for every condition and treatment they offer. Not thin pages with a paragraph and a phone number. Pages with enough clinical substance that Google treats them as legitimate answers to patient search queries.

Neck pain gets its own page. Ligamentitis gets its own page. Kinesio taping, auto accident recovery, sports injury, physical rehab—each one is a standalone URL targeting a specific search intent. The result: their 176 keywords are high-intent, conversion-ready terms, not vanity metrics.

They also did something clever with their multi-location network. Rather than running one domain for six offices, they run separate domains for each city—Allen, Prosper, Richardson, Sherman, Addison, and Plano—with cross-links in the footer. Each domain targets its own local keywords while passing authority through the network. It's a simple architectural decision that most agencies never recommend because there's no recurring revenue in it.

On top of that, they embed the same five strong Google reviews on every condition page. Google crawls that review content on every URL, which reinforces E-E-A-T signals across the entire site. The reviews aren't just sitting on a testimonials page—they're working on every page that a potential patient might land on from search.

And here's the kicker: they display insurance logos on their homepage with geo-targeted alt text. "Chiropractor in Plano TX accepting Cigna insurance." "Chiropractor in Plano TX accepting Blue Cross." These are long-tail keywords that franchise chains can never compete on because they don't accept insurance.

Practice B: High Keyword Count, Low Clinical Depth

Quick answer: 634 keywords from templated agency content. Every condition page follows the same formula with zero clinical voice. Keyword-variant spam throughout the site structure. Vulnerable to Google's Helpful Content Update.

Practice B looked impressive at first. 634 keywords from a practice with a domain authority of 10 is remarkable. But when I dug into the actual site, the picture changed.

Their website is built by a healthcare-specific web agency that sells templated content packages. Every condition page follows the same formula: an H1 tag with "[Condition] in Plano, TX," a stock photo, a "What is [condition]?" section, a bullet list of causes, a "How Our Plano Chiropractor Treats [condition]" section, and a closing call-to-action.

The sciatica page and the herniated disc page are nearly interchangeable. Swap the condition name and the copy reads the same. There's zero clinical voice—no case studies, no "in my experience," no patient stories, nothing that would require a chiropractic license to write.

The telltale signs of keyword-variant spam are all over the site structure. "Whiplash" and "Whiplash Treatment" exist as separate pages. "Shoulder Pain" appears twice in the navigation. "Sciatica" gets its own page, then "Sciatica FAQs" gets another. "Back Pain," "Back Pain Treatment," "Lower Back Pain," and "Upper Back Pain" each get their own URL. It's a separate page for every long-tail permutation.

The blog section is seven pages deep—all posted with the same batch of December 2024 stock photos, no author attribution, no publish dates. Generic agency-produced filler like "Chiropractic care offers several treatment options to relieve all types of pain and discomfort." You could paste this copy onto any chiropractic website in any city and it would read the same.

This strategy works for now because the domain has been active since 2001 and Google is still indexing these pages. But this is exactly the type of content that Google's Helpful Content Update was designed to target: thin, templated, lacking genuine expertise. One algorithm update could collapse those 634 keywords overnight.

What This Means for Your Practice

Quick answer: Three layers to local chiropractic SEO. Backlinks: neutralized. Reviews: neutralized. Content—specifically the doctor's clinical voice—is the only remaining competitive lever, and the one thing agencies cannot produce.

The data tells a clear story. There are three layers to local SEO for chiropractors, and only one of them is still a competitive lever:

Layer 1: Backlinks. Neutralized. In local markets, everyone lands in the same domain authority band. The practice with the most backlinks in this study got the least traffic.

Layer 2: Reviews. Neutralized. When every practice uses the same automation tools, reviews become baseline. Patients aren't choosing between 4.8 and 4.9 stars.

Layer 3: Content—specifically, the doctor's voice. This is the only remaining differentiator. And it's the one thing agencies cannot produce, because they don't have your license, your patient stories, or your clinical experience.

A 90-second iPhone video explaining what a disc bulge actually looks like on MRI costs you nothing. A 500-word case report about the weekend soccer player who came in unable to tie his shoes and walked out of your office three weeks later—that takes 20 minutes to write. These become the pages that rank, the pages that get cited in AI Overviews, and the pages that convert because they sound like a real doctor talking to a real patient.

The AI Overview Factor

Quick answer: Templated agency content currently gets more AI citations (well-structured, keyword-rich), but genuine clinical content gets more citations per page. As AI search improves at evaluating source quality, content with real E-E-A-T will win.

There's one more data point worth mentioning. I also pulled AI visibility scores—a measure of how often each practice's content gets cited in AI-generated search results (Google's AI Overviews, ChatGPT, Perplexity, etc.).

Practice B, the one with templated agency content, actually has the highest number of AI-cited pages at 20. This makes sense—the content is well-structured and keyword-rich, which is exactly what LLMs optimize for when assembling answers. But here's the risk: as AI search gets better at evaluating source quality, templated content with no genuine expertise signals will get deprioritized in favor of content that demonstrates real E-E-A-T.

Practice A, with fewer total pages but higher content quality, had the strongest AI visibility score relative to its page count. Fewer pages, more citations per page. That's efficiency.

The practices that will own AI search results in 2026 and beyond won't be the ones with the most pages. They'll be the ones where the content clearly came from a practicing clinician—because that's the signal AI models are learning to weight.

The Bottom Line

If you're a solo or small-group chiropractor competing against franchise chains and agency-built websites, the game has shifted in your favor. You can't outspend them on backlinks. You can't out-automate them on reviews. But you can out-authenticate them on content—because they literally cannot produce what you can.

Pick one niche. Go deep. Film the videos. Write the case reports. Let your clinical voice do what no agency content mill can replicate. The Semrush data from Plano proves the market is ready for it.

Frequently Asked Questions

Do backlinks still matter for chiropractic SEO?

Backlinks matter as a baseline signal, but they are no longer a competitive differentiator in local chiropractic markets. In the Plano study, the practice with the most backlinks (885) got the least traffic (74 visitors/month), while a practice with roughly half the backlinks got 10x the traffic. In local markets, domain authority scores cluster in the same band, making backlinks a wash.

Why aren't Google reviews a competitive advantage for chiropractors anymore?

Nearly every competitive chiropractic practice now uses CRM-driven review automation. When every practice in a market has 200+ reviews at 4.8 stars, reviews become the cost of entry rather than a differentiator. They still matter for legitimacy, but they no longer drive ranking differences between practices in the same market.

What type of content actually ranks for chiropractors?

Dedicated landing pages for every condition and treatment with genuine clinical substance. The top performer in this study built standalone pages with clinical depth, embedded reviews on condition pages, used geo-targeted insurance alt text, and ran separate domains per location. The key differentiator: the doctor's clinical voice—case reports, condition videos, patient stories. Content that requires a license to produce.

Should chiropractors pay SEO agencies for backlink building?

The data suggests this is a poor investment in local markets. A better approach: pay for a one-time technical audit, then invest in Semrush ($130/month) instead of agency retainers ($2,000+/month). The content that moves rankings—clinical case reports, condition videos, doctor-authored posts—cannot be outsourced.

How do AI Overviews affect chiropractic SEO strategy?

AI search currently favors well-structured, keyword-rich content, giving templated agency content a temporary edge. But as AI improves at evaluating source quality, content with genuine clinical voice will be prioritized. Practices with fewer pages but higher clinical depth already show stronger AI visibility per page.