"If you perform a monotonous activity daily and don't move, it's best to visit a physiotherapist before anything starts to hurt. However, patients often delay serious conditions and function through pain," says Ondrej Machovič, owner of the Delta Clinic regenerative and rehabilitation center and a doctoral student at the Faculty of Health Sciences, UCM.

Are Slovaks familiar with physiotherapy, or is it still an unknown term for us?

Many people I meet often call me a better masseur or have no idea about everything physiotherapy deals with and where it can help.

Perhaps someone reading this interview is not entirely familiar either. So, what does physiotherapy involve?

In short, it is a healthcare discipline that focuses on the diagnosis and treatment of the musculoskeletal system. Currently, it extends into many medical branches—gynecology, orthopedics, neurology, and pediatrics. Physiotherapists now work very specialized, for example, with patients after strokes, multiple sclerosis, or Parkinson's disease.

Scheduling an interview with you was challenging. Do you have a lot of work?

Yes, there's a lot to handle. My doctoral studies coincided with private practice. So, some days, I have to be at the faculty, and the rest, I'm practically in my center from morning to night. I constantly consult with clients about their health and focus on them with minimal breaks. If I have any breaks, I usually spend them with colleagues to discuss the condition of individual patients.

You're a young person, only 25 years old. It's not entirely common for someone your age to lead their facility. What is Delta Clinic focused on?

Currently, we are a center specializing in regeneration and reconditioning. My specialization within physiotherapy is neurological problems, mainly the spine. We have a colleague who focuses on women's body therapy, and another specializes in working with athletes. We aim to help a broad spectrum of patients in our profession. If a client comes to us with a diagnosis where our intervention won't help, based on our responsibility to patients, we can recommend other specialized physiotherapists or doctors.
"I did everything during school to become a physiotherapist with the best practical experience."

How did it all start?

Even during school, I did everything to become a physiotherapist with the best practical experience. When you start practicing, you need to know how to communicate with people, know every muscle in detail, and understand how to work with it and use your hands to find the problem the patient describes. I attended various courses and additional education to achieve this. I practiced in a hospital, in orthopedics, neurology, and surgery departments. I also worked as the head physiotherapist in a fitness center in Bratislava. During the COVID pandemic, I decided that it was the right time to try the path of private practice.

Did you rent premises for your own center in Trnava?

Exactly. I started with two rooms where we are currently located. They had to be rebuilt to meet the specified standards. In the first week after opening, several clients came, but the next week none at all. I got a little scared, wondering if it was the right move. Two and a half years have passed since then, and such a week has not happened again. After six months, I had so many patients that I couldn't handle them alone. I approached former classmates from high school, knowing they were quality physiotherapists. At some point, due to capacity reasons, we had to connect our facility with adjacent rooms, and today the entire ground floor of the building is Delta Clinic.

In the past, being a physiotherapist was not a field that required university studies, just a form of post-secondary education at a secondary medical school. Is it now necessary for physiotherapists to have a university education?

From my perspective, definitely yes. University education is not a guarantee that you will be a good physiotherapist, but it gives you the opportunity to specialize closely in the area you want to focus on. During the bachelor's degree, you cover general basics—such as anatomy and histology. In the master's, you have the opportunity to acquire specialized techniques in fields like gynecology, orthopedics, neurology, pediatrics, and many others.

You mentioned that you attended many courses and additional education outside of school. Are they essential for practice?

Definitely, if you want to keep up with current trends. In additional education, you find out how the field has progressed over years of research. Some methods from the past simply no longer apply. As one professor told me, learning just one new exercise can help hundreds of patients with problems. Private courses are definitely worthwhile, although they cost a considerable amount.

"Doctoral studies are great in that you maintain contact with current domestic and global research during them. You learn methodology and how to distinguish between quality and non-quality."

You have your own practice and the necessary education. Currently, you're also a full-time doctoral student at FZV UCM in the physiotherapy study program. Wasn't a master's degree enough?

Doctoral studies are great in that you maintain contact with current domestic and global research during them. You learn methodology and how to distinguish between quality and non-quality. Physiotherapy is my passion, and I would like to contribute to this field with some of my research.

What specific area are you specializing in for your doctorate?

My dissertation focuses on optimizing physiotherapy after heart transplantation, which is very under-researched. Unfortunately, there is a stigma among cardiologists, such as in the diagnosis of chronic heart failure when physiotherapists are afraid to exercise patients adequately. Therefore, I collaborated with the National Institute of Cardiovascular Diseases in Bratislava. Let's move on to more common examples within physiotherapy. A few days ago, I, colloquially speaking, "threw out my back." I couldn't move all day. I solved it with pain relievers and patches. I'm aware that this isn't the right solution, but many people behave like this.

Patients often call me with similar problems, asking for an urgent appointment as soon as possible. However, it would be a big mistake for an inexperienced masseur or physiotherapist to do so. In the case of a so-called muscle spasm, the muscle stretches due to a sudden movement and then contracts due to a defensive reaction. The muscle fibers, colloquially speaking, "tangle up." In this case, it is recommended to wait at least 24 hours before a physiotherapist can address the issue. Of course, it is possible to intervene earlier if it is an experienced professional. In such a case, it involves correct and gradual positioning, which can significantly help. The patient should not be massaged, and manual techniques should not be performed.

The best self-help relief for pain is dry heat, such as hot compresses. If you don't have anything else, hot air from a hairdryer can also help. In more severe cases, the mentioned analgesics can resolve it, and in the worst cases, seek immediate medical attention. On the contrary, the application of moist heat, such as a hot shower or bath, is not recommended. Once the acute pain subsides, visit a physiotherapist and start working on eliminating its causes.

Back pain is one of the most common chronic conditions in people with a sedentary lifestyle. On your blog within Delta Clinic, you mention that caring for the back can prevent these pains preventively. What should such prevention look like?

From an evolutionary perspective, our spine is not adapted to sit for 8 hours in one position. In the past, during the day, we spent 59 minutes in motion within one hour and one minute sitting. Today, it is precisely the opposite. Therefore, it is recommended to interrupt sitting and move. I sometimes neglect it and don't have time, but due to compensating for the monotony of daily movement, it is good to try to find that half-hour or hour during the day.
If I wanted to be confrontational, I would say that many people who study or work sitting from morning to evening simply do not have the space for it.

Therefore, it is crucial to approach each client individually and try to adapt to them. If you tell me that you are extremely busy and only have 15 minutes during the day, I will compile a few of my most urgent exercises for this time, and it doesn't have to be systematic exercise. There is a very popular McKenzie method, during which the patient exercises only one minute every three hours. It is essential for the spine to receive releasing stimuli through exercises several times a day rather than once a day.

What is the danger if back pain remains unresolved for a long time?

For example, a herniated disc can occur. Of course, it is called something else professionally, but in the end, it is not just an exaggerated layman's term. There is a disc shell with non-compressible fluid between the vertebrae. For instance, in the lumbar region, if there is prolonged overloading of the spine with high pressure and a static poor body posture, the disc shell may rupture, and the fluid with the core literally floods the nerve, which extends down to the leg. In most cases, it will immediately "shut off" your leg.

I assume that this is already a serious health condition.

Then a person is literally in the twelfth hour; they must go to the emergency room for immediate surgery. Patients often postpone such conditions, functioning through the pain. It can be solved operatively, but the leg remains immobile, and even for a physiotherapist, it is very challenging to move it. I had a patient whose nerves in the leg did not regenerate even after two years of rehabilitation, and she had great difficulty walking.

To avoid such situations, what indicators suggest that it is necessary to visit a physiotherapist?

Any back or neck pain that, for example, makes it difficult for you to concentrate on work.

"If I know that I'm doing one monotonous activity for 8 or 9 hours a day and I'm not compensating for it with any sport or other movement, I need to come. A physiotherapist will teach you how to avoid potential pain and injuries."

Does this mean that people should go to the physiotherapist as a preventive measure?

For sure. If I know that I'm doing one monotonous activity for 8 or 9 hours a day and I'm not compensating for it with any sport or other movement, I need to come. A physiotherapist will teach you how to avoid potential pain and injuries. It is the best invested money. You don't necessarily have to have a sedentary job. People in manual professions, such as those working in factories on an assembly line or athletes with unilateral stress in tennis, swimming, or hockey, perform monotonous activities with the same movements.

In one interview, I read that intense physical exertion can harm rather than help a person with a sedentary job. Why?

We also communicate with personal trainers. In the beginning, you have to start slowly. It's not the intensity that matters, but how you exercise and what movements you perform. For example, the best way to prevent back pain is to move in all directions. If the body is not used to some type of movement and you suddenly do it, pain may come. I explain to clients that if they had a bent arm in their elbow all day and wanted to straighten it in the evening, it probably wouldn't be pleasant either. Therefore, the spine must be regularly trained for all types of normal movements.

In an interview with the newspaper N, physiotherapist Petr Šifta said that in recent years, about a third of psychosomatic patients who have pain without any objective reason have been coming to his surgery. Do you also have such an experience?

Although I do not have a statistical basis for this, I also have more and more psychosomatic patients. The psyche greatly affects the overall posture of the body. For example, if you suffer from anxiety or depression, your body will automatically adopt a so-called defensive position. You try to curl up and put your shoulders forward, which shortens your pectoral muscles and overloads your trapezius. Thus, a psychological problem becomes a somatic, i.e. bodily problem, and it also works the other way around.

How do you work with such patients?

Many people with chronic pain will tell you that they have been to the best neurologists or orthopedists in the Czech Republic or Austria, but no one helped them, so they came to you. We work with them and exercises do not help. We will sit down and evaluate that they have already been to a neurologist, a physiotherapist, an orthopedist, a healer, a witch, simply everywhere. What is it that we are left with? Psychology. An answer that is difficult for many patients. Of course, it is important to stay in touch with the patient and, if the psychologist excludes a psychosomatic problem, to help him find a solution through the intervention of other doctors.

How do they respond when you let them know?

Typically, they're not crazy after all. The priority is to explain to them that they perceive pain in a slightly different way and may have a different cause than physical. It is very important to be able to communicate with them sensitively and listen to them. Often times, many clues will tell you by themselves. In medicine, a multidisciplinary connection is always best for the patient. I even recently lectured at a conference in Piešťany about the psychologist's intervention in physiotherapy practice.  

Ondrej Machovič is the owner and chief therapist of the regeneration and reconditioning center Delta clinic. He defended his master's degree in physiotherapy at the Faculty of Health Sciences of the UCM. He received the Dean's Award for excellent academic results. For the Delta Clinic project and continuous activity in physiotherapy and rehabilitation, also the Gaudeamus award - student personality of the year in the science category.