Defining and Dominating Your Niche in a Cash-Based PT Clinic

When you’re starting a cash-based physical therapy clinic, one decision will make or break your business: your niche. Without a clearly defined target audience, your marketing feels scattered, referrals slow down, and your calendar stays half-full. But once you claim your niche and commit to it, everything changes.

Why Your Niche Matters

Many new owners resist narrowing down. They’ve been trained as generalists, so they think helping “everyone” will keep the doors open. The opposite is true. Specialists get traction faster because:

• Messaging is clear: patients instantly know if you can help them.

• Referrals are easier: people recommend the “ACL rehab person” more than “the PT who treats everything.”

• Marketing becomes simple: content, workshops, and outreach are all aimed at one avatar.

The saying holds true: the riches are in the niches.

The 3-Box Test

Before choosing your niche, run it through this filter:

1. Can you help them? If you only got paid after they got the result, would you take the bet?

2. Do you enjoy working with them? Authentic energy shows. If you love the group, the work won’t feel like work.

3. Can they afford you? Passion isn’t enough. Your niche has to be able (and willing) to invest in cash-based care.

If a group checks all three boxes, you’ve got your niche.

Real-World Examples

• CrossFit: Danny started in this community when he moved to Atlanta. He had credibility, loved the culture, and CrossFitters invested heavily in training. Perfect fit.

• Runners: Years of military experience treating run-related injuries made runners a natural extension niche.

• Entrepreneurs: This niche emerged organically. Business owners sought recurring visits and valued long-term health coaching.

Notice the progression—one clear starting niche first, then natural expansion later.

The Energy Factor

Working with the right people gives you energy. You leave sessions fired up, not drained. That energy fuels content creation, in-person workshops, and long-term consistency. On the flip side, working with a population you don’t connect with will feel forced—and patients will notice.

Money and Mission

It’s tempting to pick a passion-driven niche without considering finances. But remember: no money, no mission. Without revenue, you can’t pay yourself, your staff, or invest back into the business. Once your model is profitable, you can absolutely give back through pro bono work or community initiatives.

Action Steps

• Audit your past caseload. Who did you enjoy working with most?

• Map out where these people gather—both online and in-person.

• Create three simple pieces of content tailored specifically for them.

• Book one workshop this month aimed directly at that group.

Start narrow. Dominate one niche. Expand later. That’s how you build traction fast and set your clinic apart.

Final Thought

Defining your niche isn’t about limiting yourself—it’s about clarity. Clarity builds momentum. Once you’re the go-to expert for one group, doors open to new opportunities, bigger audiences, and a thriving cash-based practice.

Resources

• PT Biz Website 

• Free 5-Day PT Biz Challenge 

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Ready to elevate your practice? Book a call at the link below with one of our expert consultants today and start your journey to delivering unparalleled physical therapy.

Podcast Transcript

Danny: 

[00:00:00] Hey Danny Matta here with PT Biz and today we're gonna talk about one thing you've gotta get right when you're starting your clinic. And if you don't, it will flatline your business. [00:00:10] So recently I was having a conversation with one of the newer mastermind clients that we have, and this person is someone who [00:00:20] previously had been in our Rainmaker program, which that program is where we help people get started and you know, be able to lead their.

Their job and go full-time into their clinic. That's the [00:00:30] intent of it. It's for newer businesses that are trying to, you know, really grow to the point where they can make that their, their entire focus, which is the goal. And when they move over to work with us in our [00:00:40] mastermind program, that's when they're really trying to scale.

They have full-time attention on that. They're trying to grow, trying to grow past themself and into a standalone space and really grow into whatever the vision for their [00:00:50] clinic is. This person was one on one of the calls that I do on ongoing basis, and one of the things we were talking about was the importance of defining [00:01:00] their niche, of getting really clear on who they were trying to work with.

And she said something really interesting, she said, until I got really clear on who I wanted [00:01:10] to work with. I had the hardest time getting traction in my business, and as soon as she defined who that ideal person was and started to [00:01:20] create content for that individual, as well as do workshops for that individual and spend time in person as well as digitally in places that are congregation points, like Facebook [00:01:30] groups with that target audience and where they are located all of a sudden.

Her schedule exploded, and this is something that I've [00:01:40] talked about a number of times, but I think it's really, really important as a core tenant of these businesses that you understand that you have to be a niche specialist, at least when [00:01:50] you're getting started. And I'll kind of explain the evolution of that that we see, but.

Defining your niche and being very clear about who you're the best in the world at helping [00:02:00] is one of the single most important things you can do in the early stages. Now, once you've done that, once you've said, I am the go-to, you know, ACL [00:02:10] rehab person in this city, I'm the go-to name the niche in this city that you are, then you can then broaden out and expand into more general work.

[00:02:20] So for me. When I moved to Atlanta, uh, in 2014, this was a new city for me. I didn't really know anybody. Um, you know, we didn't have [00:02:30] deep roots here. I had been bouncing around in the military and, uh, no one knew if I was any good at my, my job, if I was a decent clinician or not. Like it just that, that, that reputation that [00:02:40] you build doesn't transfer with you whenever you make a big move like that to a new area.

So it was starting from scratch, right? But I did get some great advice from a [00:02:50] mentor of mine who said, look, focus on the people you can help. Right? Like, stick to that. And for me, at the time, that was heavily in the CrossFit community and I [00:03:00] had been, you know, training, uh, in CrossFit gym since 2019. I had worked with a competition team out of Hawaii.

You know, I was teaching for [00:03:10] mobility law at the time, so I was. Teaching CrossFits movement, mobility, you know, trainer course, which was, I guess sort of like their, you know, movement specific, almost like injury prevention course, if you wanna [00:03:20] call it that. So I had a lot of credibility in a very specific niche.

Now, that's not the group that I probably had the most experience with because runners [00:03:30] are actually who I. Uh, had the most experience with because in the military we see a massive percentage of the injuries we see are running related. It's a running [00:03:40] related culture. I mean, I've seen so many running related injuries, it's not even funny.

But that wasn't a niche that I picked because I felt like I actually enjoyed working [00:03:50] with. The CrossFit community more than I did the runners, right? So either would have worked and, and now the, you know, athletes potential, athletes potential. The clinic that I started, they work with [00:04:00] tons of runners, right?

Uh, but the evolution happens after you dominate a niche. So, lemme talk about that for a second. And, and how, if you're sort of struggling and you're seeing mediocre [00:04:10] momentum and, and traction in your business, it might be that you're not doing a good enough job really narrowing down who you help. The most and crafting your marketing [00:04:20] message to that, your digital footprint, to that, your in-person time that you're allocating, all of that really should be going towards supporting that, that niche and showing that niche that, that you [00:04:30] can really help them and you know what their problems are.

So there's really three things that go into defining this. So, so number one is, do you have the requisite skillset to be able to help that group? [00:04:40] Okay. So for me, if, let's look at CrossFit. Did I understand it? Yes. Was I, you know, familiar with the, the sport and the training methodology? Absolutely. Um, you know, did, [00:04:50] did I feel comfortable if a CrossFitter walked into my gym or into my office that I could help them get back into the gym?

I would take that bet, right? Like, that's kind of how you have to look at it. Can you help them? [00:05:00] And the way that I always look at that is if you only got paid after you got the outcome that they wanted, would you take that bet? Because. If the answer is no, [00:05:10] then I probably wouldn't pick that niche. Right?

Like for me, if I saw, I don't know, like if, if, if it was a postpartum, you know, pelvic floor issue. I would not [00:05:20] take that bet. Like, that's not, that's not my wheelhouse. I didn't have a lot of experience with that. Um, and I wouldn't have felt competent in that type of a niche. For some of you that might be like, yeah, all day, I'll take that bet [00:05:30] and that's who you should work with.

So think of it this way. The, the, the first sort of box you have to check is can you help them? And the litmus test that I use is [00:05:40] if you only got paid after they got the result they want, would you take that? Can you take that patient on? If the answer is yes, then alright, cool. You've checked that box. So number two is, you know, do you [00:05:50] like working with them?

So there's lots of niches that work, right? I'll give you a good example. So let's say golf is a great niche in the cash [00:06:00] based community. I play golf. I'm not an avid golfer by any means. It's not something, it's not a sport that I follow. I'm not like obsessed with it. I don't know the [00:06:10] intricacies of. The injuries that come from golf swings and how that all works, the mechanics of it.

I've never done con ed courses in that at all. Could I [00:06:20] help a golfer? Yeah. Have I in the past? Sure. You know, am I the best person to do that? No. Uh, and am I gonna create a bunch of content specifically [00:06:30] for golfers? No, because I don't actually find that niche that interesting. It's not something that I have a ton of interest in personally.

So do I [00:06:40] like working with them? I don't dislike it, but it's not the first group that I'm gonna pick. Right. And I think for you, you have to decide like, who is that person on your [00:06:50] schedule that's like. In a, in a high volume clinic that you wish there were 10 people like that, that were coming in that week.

Like, what, what do they do? What, what are they trying to get back [00:07:00] to? What are their, uh, attributes as a, as a person, as a, as a client, as somebody that's, you know, you know, participating in some sort of niche and that is [00:07:10] gonna give you a better idea of who you should work with. Because if you can help those people and you get a lot of enjoyment out of working with them, the energy level it's gonna [00:07:20] take for you to get.

You know, it motivated to really be locked in to help them resolve an injury and, and, and get past, you know, these, uh, these challenges that they have. [00:07:30] I mean, it's not, it's not even gonna feel like work. It is gonna feel like fun. You're gonna have probably more energy 'cause you get to be a part of this community that you like so much.

And not only that you're part of it, but [00:07:40] you're like a, you're a big part of helping people continue to participate in that. And it's a great place to be. So the, the people that you like, it's really important that you pick a niche that you like and [00:07:50] that you can help. 'cause if you can do those two things, you're gonna be in a far better place than if you're trying to pick a niche you think.

Yeah, maybe this works better in a, in a [00:08:00] cash-based clinic, but you don't actually have the skillset to help them, and you don't even really like working with them. That's gonna just burn you out. And it's also not gonna be very helpful as far as marketing sales is [00:08:10] concerned because it's inauthentic.

People can feel that, right? Like, you really have to really, really feel that. And, and I'll tell you the, the thing that was interesting for me as we started to expand our niche, one niche [00:08:20] that I found myself. Uh, inadvertently kind of falling into is entrepreneurs. So I, you know, started working [00:08:30] with some business owners, um, and obviously like, look, if you own a business, you're listening to this.

And, and if you own a business, you understand it's mentally hard, it's a lot of [00:08:40] hours. It's, you know, you, you can take pretty poor care of yourself. And historically, most entrepreneurs are not the healthiest people in the world. So. For [00:08:50] me, I would see, you know, a couple here and there for other things. They were usually like running or maybe they were doing CrossFit or something and next thing you know, I would see friends of [00:09:00] theirs that they knew from, you know, business networking groups and entrepreneur groups.

And, uh, before you knew it, you know, I was seeing 15 to 20 entrepreneurs on a. [00:09:10] Recurring basis. This was like continuity, uh, visits for me. They were coming back in one or two times a month to check in. They wanted me to be a part of quarterbacking their health and wellness. They wanted to get hands-on [00:09:20] work done.

They wanted to start to correct some of the problems that they, you know, created over, uh, years and years of just, you know, bad, bad positioning at a desk. Uh, a [00:09:30] lot of flights, a lot of, uh, you know, just poor sleep and poor lifestyle habits. And, you know, and for me, I didn't think that was a niche that. I would kind of like try to [00:09:40] build out, but I really enjoyed working with that community.

I really could relate to them. You know, it was an, it was an enjoyable visit for me and I would always really look forward to that. And it almost felt like I wasn't [00:09:50] even working when I had a chance to work with those folks. So this is an important thing to keep in mind is, is just the, the energy level you get from working with the right people is fantastic.

And [00:10:00] sometimes maybe you don't even realize which niche you like the most. And you find that out as you start to see more and more people. But the third thing is, is just as important as the first [00:10:10] two. So number one, can you help them? Number two, do you like working with 'em? And number three is they can afford to work with you.

So this is the biggest drawback, in my opinion, to a, to a [00:10:20] cash based clinic. And it's that not everybody can work with us, right? Like I've worked with, I've worked with people from every [00:10:30] kind of background you can think of from, you know, an employment standpoint in. My cash-based clinic. So it doesn't necessarily exclude everybody, but it's harder for certain groups [00:10:40] to get in to see us.

For instance, if you're a firefighter or a police officer, like the income level that you might have, it's gonna be harder for you to afford to work with me than it would be for [00:10:50] you to go into an insurance clinic and they pay for it, right? Obviously. Um. You know, if we literally look at that scenario, in many cases, they're probably [00:11:00] still paying a good bit of money out of pocket.

So we can make a strong case that maybe we are more affordable based on just like the speed in which we can work with them. But at the end of the day, it does exclude [00:11:10] certain populations, especially lower income, um, you know, jobs or people that you know are on. Medicaid, Medicare. Like we didn't take those, um, any insurance, but we [00:11:20] didn't see those groups, you know, and, and, uh, we didn't see, you know, people that, that couldn't afford to, uh, to work with us until we got to a point where our clinic was big enough where we could do a lot of pro bono work.

And [00:11:30] that's one way to go about it too. That's sort of how we. Came to terms with the fact that there's limitations with this. And we wanted to work with certain groups and we would see youth athletes whose family couldn't afford to work with us. And, and we do pro [00:11:40] bono work with them in that capacity. So it's kind of up to you, but like when I see people and, you know, they, they pick a niche that it's just, you know, like for [00:11:50] instance, if you're doing pediatrics and it's a heavy Medicaid population, it's gonna be hard for you too.

Build a cash practice off of that, right? Because [00:12:00] inherently the Medicaid population is not going to be able to afford, or they're gonna want to use that insurance to be able to work with you. And they, they obviously don't have the disposable income to [00:12:10] be able to spend money on cash-based physical therapy, uh, you know, for, for, for many different reasons.

And. So you might really be able to help that population. [00:12:20] You may really like working with them, but if they can't afford it, then it doesn't support the business. And there's a saying that my wife, uh, well, she worked for this group called Operation Home Front when we were in San [00:12:30] Antonio. And they had a, they had a director, uh, of the, of the state.

And she's an interesting lady. A big part of what she would do is fundraising. And she [00:12:40] would always say this, she'd always say, no money, no mission. Like if we don't. If we don't get people to donate us money, then we can't support the mission that we have for Operation Home Front. And I always [00:12:50] found that to be such a great way of, of positioning it because that was the truth, you know?

And that was a fantastic nonprofit that gave like 96 cents of every dollar would go to the mission, which [00:13:00] is amazing, right? And they really, really were dependent on being able to do fundraising and to have people support them. When you look at our businesses, we are not a [00:13:10] nonprofit, but. We are very mission driven.

We're very impact driven, and at the same time, we need revenue to be able to. [00:13:20] You know, pay for life, frankly, right? Like you have groceries and a mortgage, and student loans and all this stuff. Like, uh, you have staff, you have overhead, you have benefits. You wanna [00:13:30] be able to provide your people, and no money, no mission, right?

Like without people paying you, you can't support your people. Or yourself. And that is a, a [00:13:40] challenge that a lot of clinicians have to get over. But the third variable is very, very important. If, if they can't afford to work with you, then you're gonna have a very, very hard time because you may be so passionate [00:13:50] about this group, but you can't, you can't.

You know, pay your bills if you don't have somebody that can afford to work with you in this capacity. So, like I said, you can always do the pro bono [00:14:00] side of things, and that's the way that we went about it. You know, it's something that, that if you wanna support certain groups, it allows you to do that when you have a successful business.

Um, but there's definitely certain niches that [00:14:10] are gonna be easier than others as far as, you know, being able to afford it. Like for CrossFit, for instance, whenever I started, I mean, the average gym was probably 150 to $200 a month in 2014. Right? So. [00:14:20] You know, there was some amount of disposable income just to be able to go to the gym.

You know, you look at somebody's gym bag and it's like $500 worth of lifting shoes and knee sleeves and a jump rope that cost 80 bucks, you know, that's a ball [00:14:30] bearing in there or something like that. So like they, they obviously are, they're not afraid to invest in their, in their sport and their training methodology and in themself.

Right. So it was a, it was a good natural fit for [00:14:40] me. So, like, in summary. There's number one, can you help 'em? Right? Number two, do you like working with 'em? And number three, can they pay for it? Right? And if you can match these three things up, [00:14:50] that's your niche. And once you define what your niche is, once you get really clear on that and you start telling people around you, and you start.

Start working with people that fall into that niche [00:15:00] and they can see just how awesome you are with that niche. That's where we start to see real momentum pick up. I think the challenge for a lot of people is sit down and thinking about this. You may say, [00:15:10] I've been trained to be a generalist, and a lot of us have, right?

It's like. Yeah, I can work with a lot of things, but that doesn't mean that that's gonna be the best thing for you when you start a cash-based clinic [00:15:20] because the riches are in the niches. And if you drill down to that, you're gonna find yourself with more patients than you know what to do with much faster than if you try to be the, the.

You know, the, the [00:15:30] jack of all trades and you're the expert of none and people are not gonna be as willing to refer to you and you're not gonna be as clear with the people that you can really help in your messaging, whether it be [00:15:40] content or it be, you know, education in person or digitally. It narrow, it narrows everything down.

It makes it so much easier. So. If you're struggling in the early stages, in particular [00:15:50] of getting yourself to where you can go full-time into your business, this tends to be one of the most important things that we end up working with clients on, especially in our Rainmaker program. And [00:16:00] if, if you are somebody who has just gotten started and you want actual coaching from coaches that are, you know, running cash-based clinics, successful clinics across the [00:16:10] country, and you want mentorship.

Along with a proven plan of how we help people get full-time in their clinics and be able to get to the point where they leave their, their full-time job or part-time job, and they're all in on their clinics [00:16:20] and they're on their way to scaling and growing. I would head over to physical therapy biz.com.

Take a look at it. You can learn more about our Clinical Rainmaker program. We have amazing coaches in there. We have a fantastic track record [00:16:30] and we've helped a a lot of businesses. Get started and scale to where they can go full-time and leave their high volume clinic job or their PRN job they have on the side.

Um, you know, and that's a tough stage to [00:16:40] go through. So if you're looking for support and some help head there, you can learn all about it. As always, thanks so much for listening and watching, and I'll catch you in the next [00:16:50] one.