The Challenge
What They Were Dealing With
A multi-location healthcare provider was hemorrhaging organic visibility. Their previous agency had been on retainer for 18 months, billing $8,500/month, delivering monthly reports stuffed with vanity metrics — impressions, "brand awareness," and a traffic graph that only went down. New patient enquiries from search had dropped 40% year-over-year. The agency blamed "Google algorithm updates." The real problem was simpler and uglier.
The Approach
What We Actually Did
The teardown revealed a horror show hiding in plain sight. The site had 340 pages, but only 87 were indexed. The rest were blocked by a misconfigured robots.txt that had been live for 14 months — the previous agency never checked. Service pages were cannibalizing each other because three separate "physiotherapy" pages existed with near-identical content. The site had no internal linking strategy, no schema markup, and page load times averaging 8.2 seconds on mobile because of uncompressed hero images and render-blocking third-party scripts.
We started with the technical foundation: fixed the robots.txt, submitted a clean sitemap, consolidated the cannibalizing pages with proper 301 redirects, and implemented medical practice schema across all location pages. Then we rebuilt their content architecture around actual patient search behavior — not what the practice owner thought patients searched for, but what Search Console data showed they actually typed. We created condition-specific landing pages targeting long-tail queries like "knee pain specialist [suburb]" and "bulk-billed physiotherapy near me" that the previous agency had completely ignored.
The internal linking overhaul connected service pages to condition pages to location pages in a way that Google could actually crawl and understand. We added FAQ schema to the 12 highest-traffic pages based on People Also Ask data. Every image got compressed, lazy-loaded, and given meaningful alt text. Core Web Vitals went from failing on every metric to passing all three within the first month.
The War Story
How It Actually Happened
The first sign something was working came in week three. Pages that had been sitting in Google's index limbo for over a year started appearing in Search Console's coverage report as "valid." Not ranking yet — just indexed. That's the part most people don't understand about SEO recoveries. Before you can rank, Google has to acknowledge you exist.
By month two, the 253 previously blocked pages were crawled and 189 of them indexed. Organic impressions doubled, but clicks were still modest — the pages were ranking on page 2 and 3 for their target terms. This is the valley of death where most clients panic and most agencies start making excuses. We sent a dashboard update: "Indexation recovered. Rankings climbing. Revenue impact starts month 3-4."
Month three is when the compounding kicked in. The condition-specific landing pages started hitting page 1 for low-competition long-tail terms. Each one drove 20-50 visits per month individually — not headline numbers — but collectively they added up to 800+ new monthly visits from patients actively searching for treatment. These weren't tire-kickers reading blog posts. These were people typing "sports physio bulk bill [suburb]" at 9pm with a sore knee.
The real breakthrough came in month four. Google's crawl rate for the site tripled. The internal linking structure we'd built was working exactly as designed — Google was discovering and ranking new pages faster because the existing pages were performing well. The site went from 87 indexed pages to 312. Traffic didn't just grow — it accelerated.
By month six, organic traffic was up 12,700% from the baseline we inherited. That number sounds absurd until you realize the baseline was catastrophically low thanks to 14 months of robots.txt blocking. The more meaningful metric: $1.1M in new patient pipeline attributed to organic search, tracked through their booking system. The practice opened a new location partly on the strength of the inbound demand.
The previous agency's 18 months of "building foundations" had actually been 18 months of actively suppressing the site's ability to rank. Every dollar they billed was money spent making things worse. That's not incompetence — well, it is — but it's the specific kind of incompetence that comes from agencies who don't actually check whether their work is doing anything.
Our previous agency spent 18 months "building foundations." Underdog got us on page 1 in 90 days. The $1.1M pipeline we've generated since is real money, not a projection on a slide deck.
Dr. Sarah Chen
Practice Manager, Health Provider
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