Advances in sports science are evident in 21st century. Records are being broken and new frontiers are being established while careers of professional sportsmen keep getting longer and longer. Focus is not only on training regimes, but also on other aspects of life that make sportsmen even fitter, readily reaching their top form while recovering from fatigue and injuries swiftly.
Sports medicine specialists play an important role as sports medicine is an area that is developing rapidly and requires constant research. This is exactly what made two sisters Jadranka Mandić M.D. and Jasmina Stanisavljević M.D. replace their white coats with tracksuits.
Although they’ve been in sports all their lives, they arrived into the world of medicine by accident. Older Jadranka made the initial step, recognizing potential and allure of being a sports physician, which quickly migrated to her younger sister Jasmina. They’ve been making strides on the football pitch ever since, using their knowledge and improving constantly.
Speaking to Sportifico ProFeed they talked about what the job of a sports doctors entails, differences in her work on club and international level and how to find an answer to the most common of questions: ‘When is player due to return from injury?’
Becoming the team doctor
Jadranka started out as a doctor on duty at Srem from Jakovo and after that other clubs from Surčin area began to hire her. Soon enough, calls from Belgrade clubs followed so she began working at matches set up by Belgrade FA.
As soon as Jadranka landed a job as the team physio of FK Voždovac youth setup, Jasmina started working as doctor on duty with Belgrade FA.
First match – problems with the sun and the lino
‘My first match came towards the end of the season and I had the sun in my eyes and I couldn’t see the match official’s signal. It took a few matches for me to get synchronized with the officials since I’ve never noticed that before, they don’t show you bits like that during a TV broadcast,’ explains Jadranka.
Jasmina’s first match was with Brodarac, and she had her sister beside her.
‘We were sitting together on the bench, so when this player went to the ground she instructed me how she likes to be ready and close to the line. Both of us jumped at that very moment and got cautioned by the lino,’ 30-year old Jasmina tells us through laughter
Owing to her exceptional work with U21s, the older of two sisters got the trial with the first team, which opened up the opportunity for her younger sister to take over U21s.
Player trials are also trials for the team doctor
‘The best possible trial for the team physio is traveling away to Radnički Niš or Novi Pazar. Stands are always full, you can’t hear your own thoughts amidst the roaring crowd, therefore if you can manage yourself there and do a great job, it is an indication that you’re ready for the job. I really liked working under pressure since adrenaline is pumping for the entire 90 minutes, and it showed in my performance. We signed the agreement by June already which effectively made me the only female team doctor in the Serbian Superliga’.
Answering the question on what the job of team doctor really entails, she says without hesitation: ‘Prevention, recovery, diet, rehydration, doping, quality sleep,’ to which Jasmina adds:
‘We focus on prevention and that’s where we’re most dedicated – it requires proper diet, rehydration, supplementation and training’.
The team physio is responsible for planning out the menu and Jadranka and Jasmina rely on FIFA nutrition program.
‘With diet, we aim to achieve a healthy dose of macronutrients – proteins and carbohydrates – vitamins (A, B, C, D, E, K), minerals (calcium, sulphur, iron, potassium, phosphorus, sodium and magnesium) as well as oligo-elements (chromium, cobalt, zinc, selenium, iodine, fluoride, manganese, silicon, boron and copper). It is impossible to adjust the menu energy and quality-wise for each and every player so we stick to the general guidelines. However, during the meal itself we do make some adjustments individually as it is understood players spend different amounts of energy. The difference is huge between a goalkeeper and a winger’, Jadranka explains.
Diet plan depends on many different factors such as season of the year, whether we’re in pre-season, summer or winter training camps, how many times they trained and matches played, whether season is in full swing…
‘Meals and activities are organized in agreement with the rest of the staff, mindful of the stress players will go through. Dinner after recovery training session and dinner after the match can’t be the same because of the differences in energy spent. Furthermore, during summer preparations our focus is on adequately making up for the lost electrolytes and liquids, while during winter preparations we focus on making up the lost energy with carbohydrates and protein intake’, says Jasmina.
When traveling with the team for preseason or tournaments, careful day planning and scheduling of activities is necessary.
“With regards to time of morning training session, it is necessary for players to wake up three hours before they start training and have a light meal. Following the training session, a quick restoration of carbohydrates is needed, while it is also fundamental that the meal is rich in proteins and other essential nutrients. Once done with the meal, it is recommended that they have a light walk to the food digests and body prepares for the short phase of rest before the next stressful effort. Ideally, there should be a minimum of eight hours between two training sessions in order to prevent metabolic fatigue, but this is not always possible,’ Jadranka explains.
‘When we’re taking part in a tournament, there’s usually just a single training session which, for reasons related to biorhythm, is scheduled at the same time of day their match will be played. It is recommended to finish all activities by 20:00, but that can depend upon match timetable. Dinner is planned two to three hours before they sleep in to allow enough time for food to digest. That way the players don’t go to bed feeling sluggish allowing them to rest and sleep properly,’ says Jasmina while adding:
‘Our job is not only to take care of proper diet, but also to educate players so they can take care of themselves. Minor adjustments to diet can bring about huge changes, especially for young players. All of our players know what constitutes a light, a medium-sized one and a heavy pre-competitive match meal, as well as the “rainbow” principle (nutritional diversity is accompanied by diversity in colors). A plate should consist of proteins, carbohydrates, fruits, vegetables and cereals. A complete diet gives the body everything it needs since the body is equipped to take full advantage of it’.
What was on the Brodarac menu for the tie against Manchester United?
‘My players were well aware what awaits them prior to the knock-out phase match in the UEFA Youth League against Manchester United – they had lunch four hours before the game, and spaghetti, napolitana sauce, chicken and apple pies were served on their plates. A minimum of 24 hours before the match there shouldn’t be any cucumbers on the menu. Although extremely hydrating, cucumbers digest slowly and it is hard to get them out of your system. It makes players sluggish and heavy’, Jasmina explains.
Throughout the match players spend vast amounts of energy, and it can be partially replenished in the changing room, at halftime and after the final whistle.
‘After 45 minutes, players typically consume food high in carbohydrates. Energy gels used in U21 and first team matches are not recommended in youth categories. Until they have finished developing, we avoid any artificial supplements’, Jadranka says, while Jasmina explains what happens after the match:
‘It is important to recover the amount of energy spent. We make sure they get their intake while still in the changing room. It usually consists of fruits, chocolate bars, nutritive cereals, dried fruit (because of sugar levels) and nuts because that’s how spent minerals get replenished.’
Hydration – when we feel thirsty, we’re already dehydrated
‘In the winter months when viruses roam, we put emphasis on sufficient intake of liquids and vitamins. Important is the intake of sufficient amounts of vitamin C, zinc and magnesium, while vitamin B is also added for appropriate regeneration of muscles and nerves,’ says Jasmina, while Jadranka explains the hydration process during the match:
‘The medical literature suggests intakes of small amounts of liquid every 15 minutes, but this is not possible during the match of course, so small amounts are taken before the match, at halftime and at the end. Typically these are hydration solutions that include all the nutrients, oligo-elements, and carbs in combination with water low in mineral content, still and ideally at the room temperature,’ Jadranka stresses.
Matches played in high temperatures and humidity are a major challenge.
‘In these conditions, loss of liquid is increased, and players who run 10-12 kilometers could lose up to 2% of their body mass, which is serious dehydration. In such instances, we recommend they use every break in play when close to the sideline and ask for water if the conditions allow for it,’ Jadranka says and explains the consequences of dehydration:
‘By 60th-70th minute, there could be a 30% drop in performance if a player is dehydrated. It is a serious situation, both for his health and for his impact on the pitch.’
Yet, it is necessary to be careful with intake of liquid throughout the match.
‘Small sips are recommended, no more than a liter of liquid per game, but that can depend on the player’s position. If guts and stomach are filled with water, the player becomes sluggish with bad coordination, biomechanics of his body become compromised while he still feels thirsty. Aside from water, sodium, potassium, chlorine and calcium need to be replenished since electrolytes play an important part in preventing irregular heart rate and fatigue,’ clarifies Jasmina.
Jasmina and Jadranka work with youth categories for the most part, and supplementation starts at U21 level, before it can be achieved with proper diet and hydration.
“While sportsmen are actively developing, supplementation should be avoided since they are healthy, with exceptional biological predispositions, and shouldn’t be getting accustomed to rely on anything else but their body,’ Jadranka maintains while explaining what supplementation represents at later age:
‘All through their senior careers they will face much larger protein demands, so they will intake various types of fat burners, creatine, caffeine… There will also be amino acids which help protein synthesis during muscle recovery.’
Sleep is crucial for prevention of injuries, but also during recovery. While it is important for sportsmen to get fair amount of sleep, it is also important that this sleep is invigorating because the risk of injury on the pitch decreases.
‘Research shows that if a player sleeps less than eight hours, the risk of injury increases by 30%, while this risk is over 50% if a player gets less than six hours of sleep. Due to lack of sleep, nervous system doesn’t allow for adequate coordination and concentration,’ Jadranka reveals and adds how many hours of sleep is optimal at a given age:
‘A minimum of eight hours is necessary for sportsmen who are no longer actively developing, while children are recommended 9-10 hours of sleep, especially during rapid growth phase so growth hormones can do their thing.’
No matter how well-aware players are of importance of good sleep, they will sometimes have problems going to sleep before an important match.
“Their room should be completely dark and silent, and electronic devices should be avoided in particular. Not only because we will stay up longer with a laptop or a phone, but also because light sends a false signal to the nervous system that it should stay awake,’ Jasmina clarifies.
Additionally, there are also beverages that can help you sleep, but you should use them with caution.
‘Calming substances found in most beverages could cause confusion next day, as well as heavy feeling in the legs. Although it is easier to fall asleep, this sleep isn’t invigorating. You can try with light tea, but tilia variants should be avoided, as well as basil and valerian since they are natural sedatives’, says Jasmina and adds what’s forbidden:
‘Although it doesn’t help you fall asleep, taking magnesium one hour before sleep helps muscle relaxation thus soothing entire body, combined with vitamin B6. There are also concoctions that deepen the sleep, without doping substances. Additionally, sleep can be deepened with the help of melatonin which is usually recommended when changing time zones.’
One-hour difference in time zone = one day of adjustment
‘When changing time zones, sportsmen are advised to start with adjustment before the trip, wake up time is moved gradually, as is the time of meals, training sessions and bedtime. In order for the body to adapt, for each hour of time difference one day is needed for adjustment, however because of costs and competition cycles sportsmen can’t always make the necessary adjustments,’ Jasmina reveals.
Injuries and recovery – injury mechanism and how it developed is half the diagnosis
Even though much attention is given to prevention in order to decrease the risk of injury, they are nevertheless inevitable in sports.
‘Most common are injuries suffered on the pitch. Our job is to correctly diagnose, treat and rehabilitate so players could return fully recovered as soon as possible,’ emphasizes Jasmina.
When it comes to sportsmen, recovery takes many shapes.
‘Whenever there’s an injury of lower extremities, people are usually given orthopedic casts or splints to allow for healing. However, sportsmen can’t always afford this period because other, healthy muscles will go through atrophy that will be forced to rest due to being still. This is why it is important for players to stand on their feet as soon as possible and do exercises that exclude injured muscular or ligament structure, while indirectly strengthening and stabilizing other muscle groups. Aerobic and anaerobic exercises are recommended to allow player to return to form expeditiously.’
PRICE protocol – preventing injury exacerbation
‘Up until few years back, RICE protocol was used when there’s an injury (rest, ice, compression and elevation), while these days we use PRICE. P stands for “prevention,” Jasmina elaborates.
Ice plays a very important part, both with injuries and during recovery from industrious efforts in sports.
‘Although it isn’t the most important, ice is used immediately when injury occurs to avoid swelling and decrease concentration of lactic acid,’ explains Jadranka, while Jasmine adds what is the role of ice during recovery:
‘With football players, legs suffer the most and after the match they are heavy and stressed. This is why an ice bath is recommended in order to constrict blood vessels and decrease lactic acids. Upon exiting the bath, you feel lighter again.’
The most important question – when is player due to return from injury?
‘On one hand there is the player who wishes to make a return to action as soon as possible and the coach who misses this player in the team, and on the other hand there’s us – making sure that players get fully recovered and return to pitch completely fit,’ says Jadranka while explaining the process:
‘Sometimes players feel mentally and biologically ready, but usually the process of strengthening hasn’t been completed at that point. That’s when we apply “evidence-based medicine” – clinical recommendations based on previous cases. We strive to cut the recommended period short by applying certain physical procedures (electro, magnet, laser and ultrasound therapy), at the same time making sure we don’t put the player at risk.’
However, recovery period is an individual thing and it varies from player to player.
‘Regardless of the type of injury, player’s position or age, identical organisms do not exist. This is why recovery process differs individually and return date is determined in accordance with both the player and his fitness coach.
Besides, there are standard protocols that could be used to determine if a player is fully recovered.
‘The staff and the players trust our evaluation, but there are also control procedures such as measuring muscle circumference or running speed in straight line or with a change in direction. Only when all the conditions are met we give the player permission to enter normal training process,’ Jadranka asserts.
During recovery and upon return to action we do kinesio taping method or bandaging in cooperation with physical therapist.
‘Players returning from injury mostly rely on bandaging until they become mentally aware that the injury is gone and that they can use their strength in full while in training. Whatever gives comfort to a sportsman and doesn’t cause harm is fine from our perspective,’ says Jasmina.
Trust and physical preparation
Ideally every team should have a sports psychologist, but often this role is performed by the team physio.
‘When you’ve been with the team for a longer period, players trust in you grows and they are free to confide in you. You can see that with younger players in particular. When you connect and give them maximum dedication, they can feel it. You can’t pretend with the kids,’ Jadranka reveals and Jasmina explains the importance of that:
‘If they can trust us, they will listen to our advice and implement them. That’s the advantage of working in continuity with the club. You have a chance of getting to know the players both physically and mentally, which makes the job significantly easier. You know their disease histories, how they react in a given situation, how quickly they recover and based on that you choose your approach.’
Working as team doctor for Čukarički U21s, Jadranka experienced what it’s like to work in UEFA Youth League, while Jasmina had a similar experience with Brodarac.
Younger sister’s team was more successful – Čukarički missed their chance to go through to the knockout phase by losing to Rosenborg in the closing minutes, while Brodarac fought through to the knockout phase where they were beaten by Manchester United.
‘We prepared for United the same way we prepare for every big match. What separates these matches from the rest is emotional toll,’ says Jasmina who was helped by Jadranka’s experience from the season before.
‘Playing in the UEFA Youth League comes with a special emotion. We’ve both been lucky to be working with U21s from the clubs that make you feel like you’re part of one big family. Each and every one of us gives one hundred percent, thus motivating each other. Defeat from Rosenborg was very emotional, but the experience made us connected on a higher level,’ Jadranka says.
UEFA Youth League and doping control
‘The most significant difference between preparations for regular matches in domestic championship and UEFA Youth League matches was doping control. We began with educational material, so the players understand doping is something that causes permanent harm to their bodies and their reputation. We taught them what’s allowed and what’s not, so now the players joke with me by sending me photos of their meals or cold medications questioning: “Doc, is this doping?”
Jadranka made her debut for the national team last year in Slovenia where she traveled with Serbia’s U18s headed by Miloš Velebit, while Jasmina’s first match was away at Qatar with B selection of the national team.
‘It’s nice to work with national teams, but there isn’t enough time to connect and influence players like at the club. This is partially mitigated by the fact my players gradually make their move to Jasmina’s selections, so we help each other, exchanging information and influencing them together,’ reveals Jadranka.
“My players are basically senior players and almost professionals. Typically, they arrive here from big clubs brining good habits along with them. Differences are there, but no bad habits. I try to adapt to their training regimes and make it a whole. The experiences of players arriving from foreign clubs are valuable and we learn something from their work. UEFA European U21 Championship makes for a unique experience due to special preparations and propositions of this competition,’ Jasmina explains.
Education and FIFA medical program
Just like players they work with have their ambitions of boosting their skills and moving on to a better club, Jasmina and Jadranka’s ambitions are to educate themselves constantly and follow developments in sports medicine.
‘It all began with the International Sports Medicine Congress held in 2015. in Belgrade. Since then, we’ve been trying to participate in every educational seminar that can help us improve knowledge. In this respect, FIFA went a step further with their football medicine program. This is significant because of particularities of recovery, differences in energy and biomechanics in this sport,’ explains Jadranka while adding:
‘Among other engagements, we are now part of “FIFA diploma in football medicine” program which helps us a lot. Aside from lectures in theory, a large number of studies and scientific research is included and it is interesting to learn about protocols that haven’t been put into use yet. Everything we learn is applied in practice and this is how we put two and two together.’
Other than the world’s overarching governing body, UEFA is also putting in effort to take sports medicine to the next level.
‘For beginners, it is best to undertake UEFA Football Doctor Education Program. Other than course in first aid, you can learn how to make the decision whether player stays on the pitch or not and whether it is necessary to send the player to the hospital for further treatment. UEFA also creates conferences and seminars for doctors of national teams,’ says Jasmina while explaining how they transfer the knowledge:
‘Ever since we came into the world of sports medicine, we strive to help new colleagues, but this has been on an informal level thus far. Our future goal is to create framework for anyone who wishes to get into on pitch sports medicine to go through training on the rules of sport, referee signalization, when and why should a doctor go on pitch and how long should they stay there, what’s in the emergency bag…’
At the end of our conversation, sisters talked about the value of their line of work which they do with much dedication and love.
‘It’s good to see our sports public to finally understand sports medicine doesn’t amount to two checkups a year, stamps on books and arguments with players and coaching staff about return dates for players. All of us work in the best interest of sportsmen,’ emphasizes Jadranka, while Jasmina concludes:
‘Knowledge, manners and personal integrity create the difference. If you possess these qualities, your gender and age become irrelevant. We are very proud to have contributed to the change in opinion on Serbia’s football scene. Our players and staff don’t care if we’re young and pretty as long as we do our job professionally and make sure they perform better.’
Serbian football is lucky to have experts like Jadranka and Jasmina. They live up to highest of standards with their knowledge and determination to improve, while their positive energy motivates everyone else to give their best to take the quality of football in Serbia to the next level.