Case Study: How Santin Chiropractic Achieved #1 AI Recommendation Status in 90 Days
A documented methodology for building AI search visibility from zero to #1 recommendation status across multiple AI platforms.
TL;DR: Santin Chiropractic went from invisible in AI search results to #1 recommended chiropractor on ChatGPT and Google Gemini in 90 days. The strategy combined authentic expert content (captured through structured interviews), multi-platform distribution, and technical optimization. Result: increased appointments despite stable web traffic, proving direct AI-to-booking conversion at rates up to 23x higher than traditional search.
Starting point: Zero AI visibility despite strong Google Maps ranking
Timeline: 90 days to #1 position
Method: Structured interview content + multi-platform publishing + schema optimization
Proof: Query "Recommend a chiropractor in Thunder Bay, Ontario" returns Santin as #1 on both ChatGPT and Gemini
Business impact: Appointment increases with stable web traffic = direct AI recommendation to booking
What Problem Did This Case Study Solve?
Santin Chiropractic had zero AI search presence despite strong traditional marketing performance. When potential patients asked ChatGPT or Google Gemini for chiropractor recommendations in Thunder Bay, Santin didn't appear.
This case study documents the systematic process that transformed zero AI visibility into #1 ranking across both platforms within 90 days.
Measured Results:
Timeline: 90 days from implementation to #1 ranking
Platforms: Top recommendation on both ChatGPT and Google Gemini
Query tested: "Recommend a chiropractor in Thunder Bay, Ontario" - Santin Chiropractic ranked #1 on both platforms
Business impact: Measurable increase in appointments with stable web traffic, indicating direct AI-to-booking conversion
Sustainability: Position maintained through continued content authority reinforcement
Bottom Line: AI visibility can be engineered through structured methodology, not luck or hacks.
Who Is Santin Chiropractic?
Practice: Santin Chiropractic
Location: Thunder Bay, Ontario
Market Position: Strong Google Maps ranking, solid local reputation, active traditional marketing
Initial AI Presence: Zero visibility across AI search platforms
Despite conventional marketing success, Santin faced a critical gap. When potential patients asked ChatGPT or Google Gemini "Who should I see for back pain in Thunder Bay?" Santin didn't appear.
Result: The practice was losing patients to competitors they'd never heard of.
Key Insight: Traditional marketing success doesn't translate to AI trust or visibility. In the AI era, rankings don't matter anymore—mentions do.
Why Does AI Search Visibility Matter for Local Businesses?
The patient discovery process has fundamentally changed because AI assistants are replacing traditional search engines.
Current AI Search Adoption:
77% of Americans use ChatGPT as a search engine
Nearly 25% prefer ChatGPT over Google for initial discovery
ChatGPT reached 700 million weekly active users by 2025
Shopping queries doubled in six months
40%+ of users under 35 start queries with AI assistants, not Google
How Patient Behavior Changed:
Traditional process: Discovery → Research → Comparison → Action
AI-driven process: Question → Action
Patients now ask AI "who should I see" and act on the answer without comparison shopping.
Why this matters economically: AI search visitors convert 23x higher than traditional Google users because they trust the AI recommendation and skip the comparison phase entirely. (See the full conversion data analysis here)
Critical Reality: When AI recommends you, patients book. When it doesn't, you don't exist to them.
Key Insight: AI search has collapsed the decision funnel from four steps to two, making AI recommendation the primary visibility factor and dramatically increasing conversion rates.
How Was Baseline AI Visibility Measured?
Before implementation, comprehensive baseline testing established zero AI visibility across multiple query variations.
Testing Methodology:
Platform tested: ChatGPT (GPT-4)
Primary query: "Who's the best chiropractor in Thunder Bay, Ontario?"
Result: Santin Chiropractic not mentioned
Additional queries: "Recommend a chiropractor for sports injuries in Thunder Bay" and "Who should I see for lower back pain in Thunder Bay?"
Result: No confident recommendation of Santin's expertise across any variation
Critical Finding: Traditional digital marketing success did not translate to AI trust.
Despite high Google Maps ranking, positive reviews, professional website, and active advertising, Santin had zero AI visibility.
What AI Systems Actually Evaluate
AI systems ignore traditional SEO factors. They don't evaluate website aesthetics, keyword density, or meta descriptions.
The fundamental shift: rankings don't matter anymore, mentions do. AI systems don't crawl search results—they scan content across the internet looking for who gets mentioned as authorities. (Full explanation of the rankings-to-mentions shift here)
Instead, AI systems evaluate three factors:
Clarity of expertise: Can the AI understand what you specialize in?
Consistency of authority: Do multiple sources confirm your expertise?
Corroboration across trusted sources: Is your authority verifiable across platforms?
Key Insight: Traditional SEO tactics don't build AI trust because AI systems use fundamentally different evaluation criteria focused on expertise clarity and authority consistency, not search rankings.
Why Is Healthcare AI Trust Harder to Earn?
Healthcare presents unique AI trust challenges because AI systems apply heightened caution to medical recommendations.
Industry Context:
Chiropractic industry: $15+ billion annual revenue in the US
Annual patients: 35 million Americans
Practices with AI strategies: Nearly zero
Healthcare AI Requirements:
AI systems require clear signals of authority, specialization, and credibility before recommending healthcare practitioners. This threshold is higher than for other local businesses.
What No Longer Matters for Patient Acquisition
Physical proximity to patients
Google Maps ranking
Advertising spend
What matters: Whether AI understands your expertise well enough to trust you with a recommendation.
Patient Behavior and Economics
Three in ten users trust ChatGPT more than traditional search engines. When they receive an AI recommendation, they act immediately without verification or Google cross-checking.
Economic Impact:
Average chiropractic patient lifetime value: $2,000-$5,000
Each AI-driven recommendation that converts: $2,000-$5,000 in revenue
Most chiropractors: Don't track patient lifetime value or marketing ROI
Key Insight: Healthcare AI trust barriers are higher than other industries, but most practitioners lack both AI positioning strategies and the metrics to understand why AI visibility matters economically.
How Was AI Trust Built? The Three-Component Framework
The implementation strategy focused on three core pillars implemented simultaneously over 90 days. This was not SEO or system manipulation—it was systematic trust-building.
Three Framework Components:
Authentic Content Authority Development
Multi-Platform Strategic Distribution
Technical Foundation Optimization
Component 1: How to Create Authentic Content Authority
Problem: AI-generated content fails to establish authority because it regurgitates existing information. AI systems cannot distinguish genuine expertise from recycled content.
Solution: Structured interview process to capture authentic practitioner expertise.
Implementation Process:
Conducted in-depth interviews with Santin's doctors
Captured specific insights about practice approach, patient experiences, and clinical reasoning
Documented genuine expertise AI systems could recognize as originating from actual practitioners
Produced high-volume content without compromising authenticity
Core Principle: Quantity is now as important as quality for AI visibility, but quality cannot be reduced. Content must remain authentic and experience-based to establish new authority rather than echo existing information.
Why This Works: AI systems can detect the difference between practitioner-generated insights and AI-regurgitated information because the former contains novel perspectives and specific experiences not present in existing training data.
Key Insight: Authentic expert content captured through structured interviews establishes authority AI systems can verify, while AI-generated content only reinforces what AI already knows.
Component 2: How to Distribute Content Across Platforms
Problem: AI systems continuously scan multiple sources to evaluate authority. Single-platform presence is insufficient for building comprehensive trust signals.
Distribution Channels Used:
Practice blog (primary authority hub)
Google Business page
Facebook (optimized for platform-specific engagement)
LinkedIn (professional authority positioning)
Additional relevant platforms
How Platform-Specific Optimization Works
Content on identical topics was restructured for each platform based on platform-specific best practices.
Example: A Facebook post about lower back pain followed different structural and length parameters than a LinkedIn post on the same topic because each platform has distinct engagement patterns.
Why This Matters: 54% of ChatGPT queries are resolved without web search, relying entirely on internal knowledge bases. Therefore, AI systems must clearly understand expertise through multiple corroborating signals across platforms to include practitioners in these responses.
Key Insight: Multi-platform distribution creates corroborating authority signals AI systems use to build confidence in recommendations, while platform-specific optimization maximizes the chance each piece of content is indexed and weighted appropriately.
Component 3: What Technical Optimizations Build AI Trust?
Problem: Technical inconsistencies prevent AI systems from confidently parsing expert identity and specialization.
Technical Implementations:
Corrected schema markup for proper structured data
Aligned expert identity signals across all platforms
Ensured consistent specialization messaging
Improved machine-readable clarity of expertise
How Content-Search Alignment Works
Content production was mapped to verified user search behavior:
Analyzed actual search queries and information needs
Mapped content production to verified search patterns
Ensured topic coverage matched demonstrated user intent
Why This Matters: AI systems prioritize content that directly addresses verified user queries because this content demonstrates practical expertise, not theoretical knowledge.
Guiding Principle: Technical optimization focuses on clarity for machine interpretation, not manipulation. AI systems must easily understand practitioner identity, specialization, and authority.
Key Insight: Technical clarity allows AI systems to confidently parse and categorize expertise, while content-search alignment proves that expertise addresses real user needs.
What Results Did the Implementation Achieve?
Implementation Timeline: 90 days (approximately three months)
AI Ranking Results
Post-Implementation Testing:
Query tested: "Recommend a chiropractor in Thunder Bay, Ontario"
ChatGPT result: Santin Chiropractic ranked #1
Google Gemini result: Santin Chiropractic ranked #1
Consistency: Top recommendation maintained across both major AI platforms
What Business Impact Was Measured?
Appointment volume: Measurable increase in bookings
Web traffic: Remained relatively stable (minimal increase)
What this means: The disconnect between stable web traffic and increased appointments indicates direct AI-to-booking conversion. Patients bypassed traditional website research phases, moving directly from AI recommendation to practice contact.
How Did Patient Behavior Change?
Post-implementation patient acquisition demonstrated a collapsed decision funnel:
Traditional funnel: Discovery → Research → Comparison → Action
AI-driven funnel: AI Recommendation → Direct Action
Patients who received AI recommendations contacted the practice directly or booked immediately. They skipped comparison shopping and extended review reading.
The conversion advantage: Research shows AI-driven recommendations convert at significantly higher rates than traditional search results—in some cases, 23x higher than Google users—because consumers trust AI guidance and bypass verification steps entirely. (See why AI search visitors convert so much higher)
Key Insight: AI recommendations collapse the decision funnel, resulting in dramatically higher conversion rates because patients trust AI guidance enough to skip traditional comparison and verification behaviors.
Is the #1 Position Sustainable?
Santin Chiropractic established market position ahead of competitors. Maintaining this lead requires continued content authority reinforcement but becomes increasingly defensible over time.
How the Self-Reinforcing Authority Cycle Works
AI recommendation leadership creates compounding advantages through a five-step cycle:
AI recommendations → Increased patient volume
Increased patient volume → More authentic case material
More case material → Expanded content opportunities
Expanded content → Strengthened AI trust signals
Strengthened trust → Sustained recommendation position
Why this matters: Early position establishment creates barriers to competitor entry because later entrants must overcome established authority signals, not just match them.
What Is the First-Mover Advantage Worth?
AI search adoption is accelerating rapidly:
ChatGPT: 5th most visited site globally
August 2025: Only top-10 US website with traffic growth
AI search traffic: 8.2% of total search traffic (August 2025)
Combined AI search visits: 7.5 billion (up 150% year-over-year)
Google vs. AI search ratio: Dropped from 10:1 (2024) to 4.4:1 (2025)
Implication: Early adopters are capturing territory before the landscape becomes crowded. Chiropractors who establish position now face less competition and build compounding advantages.
Key Insight: First-mover advantage in AI search is sustainable because early position establishment triggers a self-reinforcing authority cycle while creating competitive barriers for later entrants.
Why Aren't More Chiropractors Doing This?
Most chiropractic practices have not implemented intentional AI positioning strategies. Common barriers include:
Previous social media efforts showing minimal ROI
Small existing audiences (100-500 followers)
Historical content reaching only existing patients
Misunderstanding of current algorithmic content distribution
How Have Social Media Algorithms Changed?
Social media algorithms have evolved significantly. Modern platforms prioritize content relevance over follower relationships.
How it works now: Platforms function like YouTube's recommendation engine. Strategic content aligned with verified search intent reaches audiences beyond existing followers.
Implication: Practices can build new audience reach through topical authority rather than relying on existing follower bases.
Why most miss this: Practitioners assume social media still works like it did 5-10 years ago when follower count determined reach.
What Happens If You Wait?
Practices that delay implementation face increasing barriers:
Established competitors gain compounding authority advantages
Required content volume to overcome established positions increases
Investment costs rise as markets become more competitive
Every month you wait, another chiropractor in another market establishes position. Those early movers build authority that becomes harder to overcome.
Key Insight: Most practices aren't implementing AI positioning because they're applying outdated mental models about social media and content distribution, not because the strategy doesn't work.
How Much Effort Does This Require?
What Is the Content Volume Reality?
The content production volume required for AI authority building represents a full-time commitment. Practitioners attempting part-time implementation without structured processes face significant challenges.
Resource Allocation Principle: Practitioners optimize ROI by focusing on clinical expertise delivery (high-value activity) while delegating specialized AI positioning work to experienced implementers.
Should You Build This In-House or Hire Help?
Technical capability exists for self-implementation, but practical considerations favor professional engagement.
DIY challenges:
Expertise Development Time: Research and learning curve delays results
Trial and Error Costs: Ineffective approaches waste time and resources
Opportunity Cost: Practitioner time diverted from patient care
Process Efficiency: Established methodologies deliver faster results
Economic Comparison: Similar to complex home repairs, professional implementation typically delivers superior results more efficiently, allowing practitioners to focus on core competencies.
Key Insight: The full-time commitment required makes professional implementation more economically viable than DIY for most practices because practitioner time is better spent on high-value clinical work.
What Does This Mean for the Chiropractic Industry?
Does the Economic Case Make Sense?
Chiropractic practice economics support AI positioning investment:
Patient Lifetime Value: $2,000-$5,000 per patient
Traditional Advertising: Increasing costs, declining efficiency
Organic Search: Highly competitive, diminishing returns
AI Positioning: Lower competition, sustainable competitive advantage
Why this matters: A single AI-driven patient acquisition can generate $2,000-$5,000 in lifetime value. With AI search visitors converting up to 23x higher than traditional Google users (see the conversion data here), the investment becomes ROI-positive with relatively few recommendations.
How Is Search Behavior Evolving?
AI Overviews appear in 50% of Google search results
AI Overviews reduce website clicks by up to 70%
64% of Google searches end without clicks to external websites
Conclusion: Being found no longer guarantees traffic. Being recommended determines action.
What Is the Market Opportunity Window?
Practices establishing clear expert identities, consistent authority signals, and comprehensive AI trust will capture majority market share of new patient opportunities.
What happens if you delay:
Increased competition from established AI-positioned practices
Higher resource requirements to achieve comparable results
Diminished market share as patients default to AI-recommended competitors
Key Insight: The economic case for AI positioning is strong because patient lifetime value is high, traditional channels are declining in efficiency, and early movers capture disproportionate advantage.
What Are the Replicable Principles?
The Santin Chiropractic case demonstrates that AI visibility is intentionally engineered, not accidental.
Six Success Requirements:
Authentic Expertise Documentation: Capture genuine practitioner insights through structured processes (not AI-generated content)
Multi-Platform Authority Signals: Establish consistent expertise across diverse, AI-scanned sources
Technical Clarity: Ensure machine-readable expert identity and specialization through schema and consistent messaging
Search-Content Alignment: Map content to verified user intent and query patterns
Volume Commitment: Maintain consistent content production at scale (both quantity and quality)
Strategic Patience: Allow 90-day minimum implementation period for results
Core Principle: AI trust is earned through demonstrable expertise, not manipulation or shortcuts.
Key Insight: These principles are replicable across healthcare practices and local businesses because they focus on clarity and authenticity, not platform-specific hacks.
Frequently Asked Questions
How long does it take to rank #1 in AI search results?
Santin Chiropractic achieved #1 ranking in 90 days. Timeline depends on content volume, platform consistency, and competitive landscape. Healthcare practices should expect 3-6 months for measurable results.
Can I use AI to generate the content for AI visibility?
No. AI-generated content regurgitates existing information and doesn't establish new authority. AI systems recognize the difference between practitioner-generated insights and AI-recycled content. Use structured interviews to capture authentic expertise instead.
Do I need to be on every social media platform?
No. Focus on platforms where your target patients are active and where AI systems actively scan. For chiropractors, this typically includes practice blog, Google Business, Facebook, and LinkedIn. Platform-specific optimization matters more than platform quantity.
Will my traditional Google ranking suffer if I focus on AI search?
No. The strategies that build AI trust (authentic content, technical clarity, authority signals) also benefit traditional SEO. Many tactics overlap, creating compound benefits across both traditional and AI search.
However, understand that the game has fundamentally changed: rankings don't matter anymore, mentions do. Being #1 on Google doesn't help if AI systems don't know who you are.
How much content volume is actually required?
Enough to establish clear topical authority across patient concerns. For Santin, this represented a full-time content production commitment over 90 days. Expect to produce multiple pieces weekly, adapted across platforms, covering verified search intent topics.
Can small practices with limited budgets compete?
Yes, especially now while competition is low. The investment required is primarily time and expertise, not advertising spend. Early movers establish positions that become increasingly defensible, making current timing advantageous for budget-conscious practices.
The reality: Most chiropractors will try to do this themselves, realize the full-time commitment required, and either give up or execute inconsistently. Practices that engage proven systems capture position while competitors are still researching or hesitating.
The economic case: When AI search visitors convert up to 23x higher than Google users, the ROI on professional implementation becomes clear quickly.
How do I know if my content is actually building AI trust?
Test regularly by querying AI platforms with relevant local searches. Track whether your practice appears in results and what position it holds. Monitor appointment sources to identify AI-driven conversions. Santin saw appointment increases with stable web traffic, indicating direct AI-to-booking conversion.
What happens if I stop producing content after reaching #1?
Position becomes vulnerable to competitors who continue content production. Maintaining #1 requires ongoing reinforcement but at lower volume than initial establishment. The self-reinforcing authority cycle helps sustain position with continued (but reduced) effort.
Key Takeaways
AI search is replacing traditional search: 77% of Americans use ChatGPT as a search engine, and the Google-to-AI search ratio dropped from 10:1 to 4.4:1 in one year. Your future patients are already asking AI for recommendations.
Traditional marketing doesn't translate to AI trust: Google Maps rankings, reviews, and advertising don't build AI visibility. AI systems evaluate clarity of expertise, consistency of authority, and corroboration across sources.
Authentic content beats AI-generated content: AI systems can distinguish practitioner insights from regurgitated information. Structured interviews capture genuine expertise AI recognizes as authoritative.
Results are measurable and rapid: Santin Chiropractic went from zero AI visibility to #1 on ChatGPT and Gemini in 90 days, with direct business impact (appointment increases despite stable web traffic).
First-mover advantage is real and sustainable: Early position establishment triggers a self-reinforcing authority cycle and creates competitive barriers for later entrants. The window is open now.
The strategy requires full-time commitment: Content volume necessary for AI authority building makes professional implementation more economically viable than DIY for most practices. Trying to do this part-time typically results in inconsistent execution and no results.
The methodology is replicable: Six principles (authentic expertise, multi-platform distribution, technical clarity, search alignment, volume commitment, strategic patience) work across healthcare and local businesses.
Work With the Team Behind This Case Study
This case study documents real implementation work with measurable, documented outcomes. The methodology represents a proven system for building AI search visibility, developed through direct client engagement and iterative testing across ChatGPT, Google Gemini, and other AI platforms.
We specialize in AI positioning strategies for local businesses, with particular focus on chiropractic practices and healthcare providers navigating the transition from traditional search to AI-driven patient discovery.
Our approach combines:
Structured interview processes that capture authentic practitioner expertise
Technical optimization (schema markup, platform alignment, machine-readable clarity)
Strategic multi-platform content distribution
Continuous testing and verification across AI systems
What makes this different: We don't use AI-generated content or SEO hacks. We build sustainable competitive advantages through demonstrable expertise and systematic trust-building with AI systems.
If you're a chiropractor watching patients choose competitors you've never heard of—because those competitors appear in AI recommendations and you don't—the window to establish position is now.
Early movers capture territory. Later entrants pay more and work harder for smaller results.
