In the latest interview in the series “OFF THE COURT TALKS” we welcomed Makedonka Siljanoska who has been working as a physiotherapist for 18 years. She began her career at a surgery clinic, and now is working as a physiotherapist in HC Vardar 1961. Besides talking about manual techniques, injury prevention, and physical therapy she also revealed that mountain climbing and foreign languages are her passion. Enjoy your read and stay tuned because there are more great stories to come.
How long are you performing your job as a physiotherapist?
I have been working as a physiotherapist for 18 years. I worked before that, but for the last 18 years, I have been completely dedicated to physical therapy and rehabilitation only. I graduated from the University of St. Kliment Ohridski. I finished a three-year study of physiotherapy and currently, I’m in the process of preparing a master’s thesis in the field of kinesiology. In my professional career, I mostly do manual techniques like the Myofascial release technique, Lymphatic drainage, or Kinesio taping technique. Before working for Vardar, I worked in the surgery clinic in the trauma and neurosurgery departments. I also worked in the intensive care unit. So, during that time, I gained experience and education which cannot be obtained at any university.
You mentioned you mostly do manual techniques. Can you describe the Myofascial release technique?
Myofascial is a combination of two words – mio is a muscle and fascia is a sheet of connective tissue. There is no part of our body where there is no fascia. It branches out along the entire body and supports all muscles, organs, bones, ligaments, and nerves. Muscles and fascia work together, they cannot be isolated from each other. These are connected structures of connective tissue. And you can’t separate if it’s some kind of injury. It pulls the whole vertical and the whole kinetic chain, it pulls on all the neighboring segments.
Can you explain the popularity of this technique (Myofascial Release) among professional athletes?
Fascia participates in the elasticity and agility of tissues. When our fascia is normal, it is wavy and relaxed and does not create restrictions on the tissue and it slides freely. Tissue, muscle, tendon, or ligament slides freely and there are no restrictions. The volume of the movements when the fascia is relaxed is undisturbed, the movements are light. When we have an injury, the fascia shrinks and makes a protective reaction to prevent a major injury from occurring. If it is not removed manually and if it is not treated well with physical therapy, tissue scars remain. Athletes are left with bumps that can contribute to new injuries in neighboring segments. According to the research, when stretching and kinaesthetic evaluation of the tissue is done, the range of motion in the joint increases by 10%. That is why fascia is important, especially for professional athletes who should always be in top shape.
You studied at University Sv. Kliment Ohridski, where does the love for physiotherapy come from?
I have been involved in sports since childhood. I practiced gymnastics and karate. I was not into collective sports. Gymnastics is known as a sport where injuries are very common. Also, I have been interested in medicine since I was a child. I wasn’t so much interested in classical medicine, alternative directions interested me much more. Physiotherapy was the right choice for me for the part of medicine that I want to do because it has a wide range of techniques that you can apply for faster healing. Also, good results are achieved in healing, and it offered me the opportunity to work in sports.
You have been working at the HC Vardar 1961 since 2014. How did that collaboration start?
At that time, there was another organizational structure in Vardar. We had a complete sports medicine center. Not only physical therapy and rehabilitation were performed there, but also completed sports preparations, sports examinations, sport-medical examinations. There were tests for the athlete’s physical preparation and then we worked just as a center for sports medicine, which included everything that athletes need. From rehabilitation to sports examinations to blood tests and analysis. Basically, physical therapy and rehabilitation were organized in another way. My collaboration with Vardar started when the doctor who then worked in Vardar, invited me. We have worked with all clubs in Vardar, men’s and women’s handball, and men’s football teams. We did rehabilitation for all the Vardar teams.
Is there any difference in the injuries between handball and football?
Of course, there are differences because handball is a rougher sport and injuries are bigger than in football. There is no part of the body that handball players cannot injure, it is a contact sport, and they are like gladiators in the arena. One can never predict what may happen. From a stretched shoulder to a twisted wrist or a cracked arcade. There is a lot of difference between these two sports. In football, the lower extremities are mostly affected – most often distortions, adductor injuries, sprains. On the other hand, handball players have a little more workload and bigger injuries.
What are the most common injuries in handball?
Well, the lower extremities and the anterior cruciate ligaments are most often damaged. Also, because of specific jumping and jump shots, ankle distortion blows, contusions on the thigh muscles are very common. A lot of handball players suffer from shoulder injuries.
You are currently working with the senior team, have you worked, or you are currently working with the younger teams in Vardar?
There used to be academies for the handball players. These are the younger categories and they had organized treatments for physical therapy and rehabilitation. But basically, the treatment is the same, whether he is a senior or from a younger team. We look at everyone as a patient whose injury needs to be addressed. However, we are now in a reduced system and when we have important matches, more emphasis is placed on the senior team. Because they have a busy calendar – the EHF Champions League, the SEHA League, the Macedonian Championship, and juniors only play the domestic league. Very few of them are involved in the SEHA League or the EHF Champions League. But the treatment is the same for both seniors and younger age groups. Everyone gets what they need.
In addition, you have a license for SonoSkills. Can you tell us something more about this licence?
I received the SonoSkills license after the training organized by SonoSkills Croatia under the auspices of SonoSkills Netherlands. A regional educator from Croatia, Mr. Zoran Filipović, my colleague is leading those trainings. It was organized in Skopje. I was trained in musculoskeletal ultrasonography, in the domain of my work and I got a license for the musculoskeletal system. When an injured athlete comes to you, we as physiotherapists do a physiotherapeutic assessment and make a diagnosis. We used to have that ultrasound at the club, and it was good to confirm the suspicion of what could be about the injury. We did that but we don’t have the conditions for that at the moment. When it comes to a major injury, a different approach is needed. We send athletes to the clinical center when major tests need to be done, it is not enough just that diagnostic ultrasound.
Can you tell us something more about Kinesio taping method?
Kinesio taping is a method dating back to the ’70s. The founder is Mr. Dr. Kenzo Kase, basically, Kinesio taping is a technique that is based on the natural healing process of the body. The concept consists of gluing the tapes, which causes stimulation through the skin, and these tapes can be of different thicknesses and elasticity, they are sticky, but there are no pharmacological properties of the tape.
They work in essence, aiming to move deeper layers in the body. To stimulate at one level of the deeper layers, to start the process of healing only, to recover the tissue. With straps, Kinesio taping follows the basics of kinesiology, the basics of movement, so that it facilitates the mobility of the joint, depending on what we are treating. We can use the tape to help if a joint has difficulty moving. With taping, these strips can relax the tissue or strengthen it a little. If the joint is loose, an application should be glued to stabilize it or vice versa. If it is stiffer and if there is a problem with the range of motion, applications are applied that would release that tissue. Taping acts on all tissues as I mentioned, it acts over the skin on the tendons, in the deeper layers just that fascia frees up the space created by lifting, the tissues are released. Then the movement is improving. Let’s say when we have an injury accompanied by swelling, such as lymph accumulation. With the special strips that are applied, the accumulation of the fluids is returned to the system, which means that the swelling is reduced. We also notice that in addition to the swelling, we have automatic inflammation of the tissue, so that the injury does not increase, it is a real protective mechanism. With adhesive tapes, these inflammations are eliminated, the tissue is cooled, this happens when the fluid is trapped and when it is released, it returns to the system, leaving us with a space where good tissue circulation can occur.
How popular is this method in handball?
I use it in handball, however, it is not that popular. Because in handball, the classic tape is more popular. Since ankle sprains are common, handball players are used to a little harder taping, not the classic one, because sometimes there is a prejudice that it won’t help much. When there is more release of muscle fascia, when I have some muscle spasms, I definitely put Kinesio tape because it really has good results, although we still use classic tape for stabilization.
Can you describe your work course when it’s match day? What are your main tasks? Is the matchday any different than other days?
When it’s match day, then you need to be 100% ready. The day before the match is a day that is a little more intense because no athlete wants to have problems with their body, and they always want to be in the best shape and best prepared for the match. On the day of the match, I prepare electrolytes, isotonic, and supplements and do warm-ups with the players. Every player has their needs and according to that, I’m doing these isotonic and electrolytes. When the matches start, I have a big responsibility and I have to be 200% ready because during the match you never know what can happen. I follow the condition of the players, if they feel tired, we add some energy supplements to lift and to hydrate them. So, the most important part during a match is to be careful.
Vardar 1961 is a professional club that plays its domestic league, EHF Champions League, SEHA League, and cup. There are a lot of matches in question, a lot of training and activities. How often do injuries occur?
It can never be predicted, there are always unexpected injuries that happen during a match. The most important thing for injury prevention is fitness training. In this way, muscle and connective tissue are prepared for the effort to which they are exposed. Athletes must do stretching before and after training, and if they have any problems, they stay for a massage. In this way, all problems are eliminated immediately, in order to prevent all injuries that may occur. An insufficiently prepared and warmed-up athlete is at the greatest risk of injury. Our job is to make sure that athletes are well-supplied, hydrated, sufficiently supplemented, and that all current problems are solved. We leave nothing for later. It is better to act before than to wait. But you know how nothing is ever known in handball because it is the toughest sport. We cannot know how the opponent will behave and play.
What is your advice for quality recovery after the injury? What is the most important thing in the process?
It depends on how serious the injury is. If there is a serious injury, it is a bit more complicated because we have to consult with our club doctor for further tests and examinations. Then when we get instructions from the doctor, we can start with physical therapy. On the other hand, if there is an injury that we can recognize, we immediately start with physical therapy and rehabilitation. It is in everyone’s interest to get the athlete back into the training process as soon as possible. That’s why I say it depends on the severity of the injury. We use all our resources, experience, technique, and equipment because the most important thing for us is a speedy recovery.
Besides the busy professional life, how do you like to spend your free time? Where do you find peace and rest?
I love mountains, hiking and I love winter sports. There is a mountain near Skopje, so every time I feel the need for some me-time, I go hiking. It helps me to deal with all the obligations and stress. I also ski and I sang in the choir. Before the Covid-19, it was also a place where I could regain my energy.
We have seen that you can speak several languages, how did you not study a language? Where does love for languages come from?
Well in school we learned two languages – French and English. I read French more than I speak, but now we have a lot of French people in our club so I can practice that now. I learned Italian, I just wanted to learn it. One of my favourite languages is the one I wanted to listen to and speak. It just came so naturally, I want to communicate with people, I want to speak all languages. We have athletes who come from all over the world, at least I want to learn how to say hello.
What is your advice that you would give to all future physiotherapists and those who want to become it?
This is a profession you need to love because you work with humans, and everyone should get their own individual treatment. Each patient is for himself, viewed individually. It takes a lot of learning, a lot of upgrading. I stick to that and I’m still learning today, and I want to continue to learn new things and techniques because I think a person can never learn enough. My message to future colleagues is to do the work with love, if they have it, if it fulfills them, to invest in upgrading themselves. Because I think it’s a treasure you can never lose. The material, today you have tomorrow you don’t have. This self-investment is a treasure that remains and is worth it.