Show Notes
I spent the better part of a decade buying MSK practices before I ever helped anyone sell one. I founded a physiotherapy clinic group in my twenties, growing it from a single site to 36 locations. Acquisitions were a significant part of how we scaled. I would sit opposite an owner, run the numbers, and work out what I was prepared to pay, doing this more times than I can count. Aged 30, I went through my own exit to a private equity firm. This experience and the lessons it taught me form the foundation of Verilo, the specialist brokerage firm I now run. Our team has advised on over 100 transactions representing more than £30 million in deal value. We work exclusively with health, medical and wellness business owners, sitting opposite buyers of every kind; from individual practitioners picking up their first clinic, to consolidators and private equity groups acquiring at scale. I explain this because this article’s themes are not theoretical; they are based on practice, where we observe the same patterns and mistakes being made. The reality of what makes an MSK practice more or less valuable to a buyer is often different to its owners’ assumptions. And that value is rarely based on the things people spend money on in the months before going to market. What a buyer is really paying for When I was acquiring clinics, I was not looking for the nicest waiting room or the fanciest website. I was looking for something that would hold together once I had taken over. The right foundations: a loyal patient base, a team that was not built around a single person, and a local reputation that had taken years to build and could not be replicated overnight. Those foundations pointed to something more important: a business that could run, retain patients, and generate revenue regardless of who was at the centre of it. Repeatable systems, consistent revenue, and a predictable diary. That kind of business takes years to build. When I found it, I found something genuinely worth paying for. The mistake I kept seeing was sellers spending money on the wrong things. A new waiting room, a rebrand, a website refresh – all fine, but none of them moved the dial for me as a buyer. If a business was performing well despite a dated website or an unloved interior, I saw that as upside. Mine to capture, once I took over. Far more appealing than paying a premium for improvements the seller had already funded. Not every buyer thinks like me, and investment is not always wasted. But the principle holds: cosmetics are easy to fix. The foundations of a business are not. What walks out the door with you? If I had to reduce everything about MSK practice saleability and valuation down to a single idea, it would be this: the more transferable a business is – and therefore the lower risk a buyer perceives – the higher its value and the more likely a sale. When you exit, how much of what you’ve built walks away with you? And how much stays? The lease is a good place to start. Most buyers want security of tenure above all else – confidence that the practice can continue trading where it is. Long-term certainty reads as an asset; the absence of it creates risk. A short, rolling or unrenewed lease may feel like flexibility to a seller, but a buyer sees it differently: a problem to be priced in or resolved before exchange. If you are approaching a sale with less than three years remaining, exploring renewal or extension options is almost always worth doing, even if your own timeline is uncertain. Brand identity follows a similar logic. A brand that patients associate with the practice rather than the person running it is transferable; one synonymous with the owner has an expiry date. Evolution should happen gradually and well in advance, creating time to establish patient associations a buyer can actually see and value. A well-maintained, GDPR-compliant client database is also crucial. It is a transferable asset in its own right – one that gives a buyer the ability to market
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It always struck me as bizarre that sports medicine and musculoskeletal specialties deal with pain and dysfunction from head to toe in the human body, yet offer little health literacy or inclusion of the pelvic floor. Traditionally considered taboo and someone else’s remit, men and women with issues affecting the pelvic floor have largely suffered in silence. Thankfully, change is afoot, and healthcare is finally evolving. There is much more awareness, inclusion, and understanding of this unique body area and the role that it plays. For anyone playing catch up, the pelvic floor is a group of muscles spanning the base of the pelvic outlet in layers. While both men and women have a pelvic floor, the pelvic outlet is wider in females than in males and it also contains an extra orifice – the vagina [1]. That’s right, we went there. We said the ‘V’ word. Because just like vulva, or vestibule, the vagina is simply an anatomical term. It needn’t be embarrassing or taboo. Some of you will be long enough in the tooth to remember when the word ‘breast’ was taboo. However, with healthcare campaigns for breast cancer and breastfeeding, this term became an anatomical norm. We need to do the same for the pelvic floor and its related anatomy and physiology. What does the pelvic floor do? In both men and women, the pelvic floor serves to control the bladder and bowel (maintain continence), empty the bladder and bowel (voiding and defecation) and support sexual function (arousal and climax). In women, the pelvic floor also plays an important role in pelvic organ support. Remember that extra orifice I mentioned earlier…well this area is high risk for connective tissue laxity and defects meaning that the pelvic organs (bladder, uterus, rectum) can descend into the vaginal cavity causing symptoms of heaviness, pressure and a sensation of ‘something in the vagina’. What are the signs and symptoms of pelvic floor dysfunction? If the pelvic floor is not doing its job, any of its roles can become compromised. This may manifest in leaking from the bladder or bowel, inability to fully empty the bladder or bowel, pain ‘down there’, sexual dysfunction (compromised erection, dyspareunia, pain with climax) or heaviness and pressure in the vaginal region (for women) [2]. A full list of sex-specific signs and symptoms of pelvic floor dysfunction can be seen in Table 1. Table 1 - signs and symptoms of pelvic floor dysfunction in men and women Who gets pelvic floor dysfunction? Pelvic floor dysfunction can affect any man, woman or child, however it is particularly problematic for women, especially during transitional life events, such as pregnancy/childbirth and the menopause [1]. One in three women will experience pelvic floor dysfunction [3] and for those that engage in sport, the prevalence of symptoms varies according to the load demands of the activity. For example 61% of netballers leak urine [4], up to 43% of female rugby players leak [5], and 32% of gymnasts experience incontinence [6]. Structural changes associated with vaginal childbirth and aging, as well as lower levels of oestrogen to lubricate and bulk out the tissues can increase the odds of experiencing pelvic floor dysfunction. However, even young adolescent females can leak urine due to the load demands of their sport. For example, in athletics and gymnastics, stress urinary incontinence (the involuntary leakage of urine during activities involving high levels of intra-abdominal pressure) is commonly experienced. Yet no-one is doing anything about it. No one is screening. No one is signposting. No one is educating these younger athletes that pelvic floor symptoms are not to be expected and normalised. Or that they simply indicate that the sporting demands exceed the load capacity at the pelvic floor. If this was any other area of sports or MSK practice, would we settle for a load capacity that does not meet the demands of the sport?! Why is this relevant to every therapist, no matter their di
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This is a free preview of a paid episode. To hear more, visit mskmag.substack.com
This is a free preview of a paid episode. To hear more, visit mskmag.substack.com
This is a free preview of a paid episode. To hear more, visit mskmag.substack.com