The Facebook Paradox: What Works Now for Chiropractors
- Dr. Lucas Marchand
- Oct 9
- 9 min read
Updated: Oct 11
In 2017, I spent $400/month on Facebook ads and got twenty-seven new patients. A couple years later, I spent $400 and got three — two of whom never showed up for their appointments. I kept thinking I was doing something wrong, and that maybe the whole thing is just broken now.
My frustration reflects a broader confusion among small healthcare providers trying to navigate digital marketing in 2025. The platforms haven't disappeared — Facebook still has over three billion users — but the rules have changed in ways that feel both subtle and profound. The question isn't whether Facebook still works. It's what "working" means now, and whether that aligns with what a small practice actually needs.
For the practitioner whose hands-on, deeply personal work is about correcting imbalances in the human body, the digital marketplace often feels like a sterile, even hostile, environment. You're skeptical about the efficacy of a platform like Facebook, and you have every right to be. Where once it was a lively waiting room for new patients, it now feels more like a crowded, noisy expo full of low-quality solicitations and automated chatter.
Yet, to dismiss it entirely would be to ignore a fundamental truth of modern practice: visibility is a precondition for care. A patient cannot benefit from your skill if they cannot first find you, trust you, and easily reach out.
The goal, then, is not to chase fleeting likes or low-quality traffic, but to establish a robust digital system—a protocol—that converts skeptical searchers into confident patients. We must stop using Facebook as a lottery ticket and start using it as an essential triage tool
The Death of Ambient Broadcasting
Let's start with what doesn't work: posting and hoping.
The original formula—the daily post to a Business Page, hoping for traction—is now clinically obsolete. The algorithm, like an overburdened system, has deprioritized passive company updates in favor of genuine human connection and immediate entertainment.
The average Facebook business page now reaches less than 2% of its followers organically. That means even if 1,000 people "like" your page, maybe twenty of them actually see what you post. This isn't a bug; it's the business model. Facebook has essentially converted what was once an organic visibility tool into a pay-to-play advertising platform.
The engagement you do get is often misleading. I have noticed that my posts would accumulate likes and comments, but when I looked closer, many came from accounts with generic names, stolen profile photos, or followers exclusively from overseas bot farms. These weren't potential patients. They were engagement pods — networks of accounts that like and comment on each other's posts to game the algorithm. I realized I was getting excited about completely meaningless metrics. It was like celebrating Monopoly money.
What is demonstrably dead:
The idea that a loyal following will consistently see your updates
Organic reach as a meaningful metric (often less than 2% of your followers)
Likes and shares as indicators of business value
The notion that daily static posts deliver therapeutic value to your practice
Spending effort on daily static posts is akin to trying to solve a complex spinal issue with a generic heat pack—it feels like work, but delivers no real therapeutic value.
The Sophisticated Age of Paid Ads
Paid advertising on Facebook can still generate patients, but it requires a level of sophistication that feels designed to favor large marketing agencies over solo practitioners. The platform's targeting capabilities have been significantly weakened since Apple's 2021 iOS privacy changes, which allowed users to opt out of cross-app tracking. This means Facebook knows less about who sees your ads and can't track conversions as reliably as before.
The leads that do come through have changed in character. I found myself fielding more inquiries from people seeking free services, discount hunters, or individuals who clicked on my ad but had no genuine interest in chiropractic care. The math told the real story: a $20 lead looked affordable until I calculated that only one in three leads actually booked an appointment ($60 per booking), and only half of those showed up ($120 per patient who paid)..
Yet, amidst the noise, some ads still work. Paid advertising is not a blunderbuss; it must be a scalpel. The old system of broad, generic ads is ineffective because privacy shifts have blunted the instrument of wide-net tracking.
The Precision Targeting Protocol
The ads that still convert tend to share three characteristics:
1. Specialization as Focus
Generic "Chiropractor Ad" is too broad. Become the acknowledged expert by advertising a specific solution: "Sciatica Relief Specialist" or "Mobile Chiropractic for Expectant Mothers." This pre-qualifies the patient and elevates your perceived competence.
A simple ad that says, "Mobile Chiropractor in Sioux Falls — We Come to You" will outperform a glossy "Wellness for All" campaign every time. Specificity builds trust and reduces irrelevant clicks.
2. The Retargeting Loop (The Pre-Surgical Scrub)
Do not send your direct offer to a cold audience. First, run short, inexpensive educational videos (e.g., "Three Stretches for Desk Workers"). Next, and this is the crucial step, use a small budget to retarget your direct offer only to the people who watched 50% or more of that educational content. They are now "warm" and primed—they know, like, and trust you enough to listen to your call-to-action.
This strategy requires building an audience first through educational content — posting videos about sciatica management without any sales pitch — then retargeting those viewers with direct offers only after they've engaged. It's slower than the old "blast an ad to everyone in a radius" approach, but the leads that emerge tend to be genuine.
3. The Conversion-Ready Landing Page
Never send an ad click to your busy homepage. Every ad must lead to a specific, minimal-information landing page built only to convert that single offer (e.g., a Free Mobility Screen). The system must be clean and without distraction to complete the intended action.
Send clicks to a dedicated page about one condition — say, "Back Pain Relief in Sioux Falls" — that clearly funnels them to book.
If you're willing to invest $200–400/month and stay consistent, you can still pull in quality leads — just don't expect the wild ROI of 2016.
Where Facebook Actually Shines Now
Yet Facebook hasn't become useless. It's simply migrated from being a patient acquisition tool to something more subtle: a trust-building and credibility platform.
If Facebook no longer serves as the primary acquisition engine, what is its vital function? It is now the site of final due diligence.
When a local patient searches for "chiropractor Sioux Falls," they will inevitably land on your Google Business Profile first. But before they book, they pivot: they search your name on Facebook. They are looking for social proof and a sense of your practice's current vitality.
The platform now functions like a digital storefront. What they find there matters. That digital storefront tells a quiet story: Are there real reviews? Are you active in local groups? Are there videos showing you interacting with patients?
The Trust-Building Protocol
Audit Your Reviews
Facebook reviews remain a critical factor. Encourage satisfied patients to leave them. A blank review section reads like a closed sign. Reviews carry weight — patients still read Facebook reviews even if they found you elsewhere.
Embrace the Hyper-Local
The highest return on your organic time will be spent personally engaging in local community groups (e.g., "Sioux Falls Moms," neighborhood chats). You are not to spam them with offers, but to answer genuine questions, offer brief, non-diagnostic advice, and establish yourself as the community's musculoskeletal resource. This moves the conversation from the anonymous public square to the intimate local circle.
In Sioux Falls, for example, engaging — not advertising — in community groups can bring genuine inquiries. A simple comment like, "I do house-call chiropractic, happy to help if you need a quick assessment," is often worth more than any ad. Active participation in neighborhood groups, done carefully and without spam, can generate genuine inquiries from people who see you as a community member rather than a marketer.
The Seamless Inlet
Ensure Facebook Messenger is active and monitored. For many, especially younger demographics, this is the lowest-friction path to a first inquiry. It is your after-hours, digital front desk. The Messenger function provides an easy, low-friction way for people to ask questions without committing to a phone call. Many patients, especially younger adults, would rather message than call.
I now checks Messenger daily and find it generates more qualified inquiries than an ad campaign. Someone will message at 10 PM asking about sciatic pain and by morning, we've already scheduled an appointment. No phone tag, no friction.
Short-Form Video Content
Short-form video content — Reels that can be cross-posted from Instagram or TikTok — keeps your profile from looking abandoned without requiring separate content creation. I'll post thirty-second clips showing common stretches or demonstrating my mobile setup. These rarely go viral, but they signal that my practice is active and current, which matters when someone is deciding whether to book an appointment.
Facebook's answer to TikTok isn't groundbreaking, but it's cross-postable. One short, educational video about posture, back pain, or mobility can live on three platforms at once — and that consistency is what keeps your name in circulation.
The Hierarchy of Digital ROI
The uncomfortable truth is that for most small chiropractic practices, Facebook marketing delivers the highest return when it's not the primary marketing channel. If you have a limited marketing budget—of both money and time—you must be ruthlessly surgical about where you apply your effort.
My best patient acquisition comes from my Google Business Profile, which captures people actively searching for chiropractic care at the moment they need it. My Instagram Reels build brand recognition among younger patients. My email reactivation campaigns — simple messages like "Hey, haven't seen you in a while, how's that shoulder?" — generate more appointments per dollar spent than any Facebook ad campaign.
Where the Real Returns Lie
1. Google Business Profile (GBP)
This is the most potent acquisition channel for any local service provider. It is where a patient with acute pain looks for help right now. Time spent optimizing your GBP (photos, accurate hours, and soliciting new reviews) will yield the highest return. Nothing beats it for search intent. People typing "chiropractor near me" are ready to book.
2. Video Content Multiplication (Reels/Shorts)
A single well-produced educational video should not live in a silo. Cross-post the same short, impactful videos (e.g., "How to Load a Carry-on Bag to Save Your Back") to Instagram Reels, YouTube Shorts, and Facebook Reels. This is efficiency. Great for credibility and long-term visibility.
3. Reactivation Protocol
An existing patient is always the lowest-cost "new patient." A simple, automated email or text message check-in (e.g., "It's been six months; any new stiffness we can address?") often generates a higher ROI than any new ad campaign. A quick "Hey, how's your back been feeling lately?" often outperforms any paid ad.
4. Nextdoor
The neighborhood app Nextdoor, often overlooked, frequently outperforms Facebook for local service providers. The audience is explicitly local, the context is community-oriented, and the platform hasn't yet been overwhelmed by corporate marketing. I would suggest spending sixty minutes a week answering health questions on Nextdoor — not promoting your services, just being helpful — and it could generate two to three inquiries a month.
Facebook sits in the middle of this ecosystem, not driving the engine but keeping the machine running. It provides social proof. It offers a communication channel. It allows for some geographic targeting that can supplement other channels. But it's no longer the workhorse it once was.
The Modern Framework
What emerges from all this is a framework that treats Facebook not as a silver bullet but as one component in a layered system. The modern chiropractic digital strategy is one of system optimization, not hope. Facebook is no longer the patient hunter; it is the credentialing service that allows high-quality leads generated elsewhere (Google, personal referrals) to confirm your competence and easily begin the dialogue.
The work is to transition from simply broadcasting to building a pre-qualified audience.
You maintain an active presence to establish credibility. You use targeted ads sparingly, focused on retargeting or highly specific campaigns. You participate authentically in community spaces. You cross-post video content that requires minimal additional effort. And you measure success not by clicks or engagement but by actual patient appointments from identifiable sources.
I now spends very little a month on Facebook ads, down from $400, and I focus that budget entirely on retargeting people who've visited my website. I will posts daily — short videos mostly — and spends an hour each week in two neighborhood Facebook groups. I have adjusted my expectations. Facebook isn't bringing me 25 new patients a month anymore. It brings one or two, supports five more who found me elsewhere, and provides a venue where past patients can leave reviews that influence future ones.
The Takeaway
Facebook is no longer a faucet you turn on for instant new patients. It's a mirror — one that reflects how your community perceives you.
Used poorly, it's a time sink. Used strategically, it's a credibility engine that feeds everything else: Google traffic, referrals, and long-term brand recognition.
In the end, Facebook's evolution mirrors the profession itself. Chiropractic, like marketing, thrives on trust, consistency, and care over time. Patients — and algorithms — can tell the difference between noise and something genuine.
I finally stopped expecting it to be 2017 again. Once I did that, I could see what it actually does well.
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