A managed physiotherapy network, quietly compounding.

We bought a Canadian paramedical chain in 2017 with the conviction that disciplined operating ownership — not roll-up financial engineering — was the unlock for a fragmented category.

Multi-disciplinary paramedical care has durable insurance demand, recurring patient life-cycles, and almost no professional capital chasing it in Canada. The asset itself was rougher than the thesis: service quality varied wildly between sites, partner clinicians ran their own playbooks, and unit economics were positive in name only.

We worked it for years before we worked it well. Five locations early, rebuilt location by location until the service standard held. The business held — but it didn't earn the case study.

By early 2023, the network had grown to just over forty managed locations — and been cut back to five. Mystery shopping confirmed what the numbers showed: partner performance was inconsistent, churn ran above 40%, and the operating model wasn't working. We rebuilt to the mid-teens, then overhauled again — cutting the largest remaining account, a four-location chain that still wasn't performing. RDG injected capital, took full operational control, flattened the sales model to one small team serving the whole account base directly — leveraging automation and AI — and started the sequence. Churn all but disappeared.

That second overhaul looked like a loss on the page. Cutting your largest account in a single month is not a move the spreadsheet can tell from a collapse. It wasn't weakness. It was the cleanup that removed the last drag.

Thirty-four months later: 80 active locations through July 2026, with pipeline to 90+ by year-end. Material dollar churn near zero. Billings up >8× from the September 2023 trough — $340K in July 2026, a ~$4.08MM annualized run-rate. Fixed cost coverage swung from negative to a credible 3× line tracking by year-end 2026. New leadership embedded. Digital systems overhauled. A scalable managed-services model deployed across the network.

Today's Align is structurally a different business than the one we bought. The change is in the contracts, the systems, and the people — not the brand on the door.

Five-year customer contracts. True recurring revenue. Installed-base net dollar retention above 120% on a deliberately conservative, ramp-aware cohort calc (the mature 2-yr cohort ran 136.5%) — the installed base expands on its own. Sub-5% core churn. 65%+ CAGR on locations. Automation, screened bookings, and an AI receptionist holding the front desk. Team tenure two to three times the industry average.

The business today produces approximately three times the cash flow of the original cheque, with a credible path to over five times in the next twelve months — run by a lean core team leveraging hundreds of allied professionals through Silver Birch Growth and location partners.

Multi-disciplinary paramedical at this footprint is one of the few service businesses that genuinely scales — and one of the hardest to stand up from scratch. The moat is built in years, not quarters.

Copying the surface is easy. Copying the bench isn't. The model requires dozens of partner-run locations, owner-operator partners with real skin in the game at each one, and a staffing network deep enough to keep every chair covered — across vacations, leaves, parental gaps, and growth weeks. We've been compounding that bench for nearly a decade. New entrants spend years just getting the staffing rails in place, and they pay for that learning out of partner margin — which is why most attempts collapse before the network reaches the scale where the unit economics finally work.

What this earns is rare: a service business that scales without taking on the operational risk that breaks most multi-site rollups. Coverage when a therapist is out. Capacity when a partner wants to open another room. A profit line that holds for the partners while the network keeps adding locations. For capital partners looking at the category, that combination — durable insurance-paid demand, owner-operator alignment, and a staffing moat that can't be bought in a quarter — is what makes Align worth owning rather than imitating.