Gesellschaft für Orthopädisch-Traumatologische Sportmedizin

Biathlon: Massenstart, Staffel, Sieg und Tränen

Vom 12.-23.Februar 2020 findet die Biathlon-Weltmeisterschaft im italienischen Antholz statt. Bei Frauen und Männern gibt es in gleich 7 Disziplinen (Sprint, Verfolgung, Einzel, Massenstart, Staffel, Mixed-Staffel und Single Mixed) Medaillen.


© Pixabay

Biathlon

Biathlon (griechisch für Doppelkampf) ist ein olympischer Winterwettwettkampf, bestehend aus Skilanglauf (seit 1985 ausschließlich in der Skatingtechnik) und Schießeinlagen mit Kleinkalibergewehren (Kaliber 22, 5,6mm). Die kreisrunde Trefferfläche der 50 Meter entfernten Metallscheiben hat bei den Schießeinlagen in liegender Position einen Durchmesser von 4,5 cm, in stehender Position beträgt sie 11,5 cm. Die zu laufenden Streckenlängen variieren zwischen 6 km (Staffel Frauen) und 20 km (Einzelwettkampf, Männer).

Die Einführung neuer Wettkampfformen während der letzten Jahre, mit einer deutlichen Betonung der Schießeinlagen, hat zu einer wesentlichen Attraktivitätssteigerung mit entsprechender medialer Aufmerksamkeit in Europa geführt. Biathlon gehört heute in Deutschland zu der medial beliebtesten Wintersportart.

Der erste olympische Biathlonwettkampf (Einzelwettkampf, 20km) fand 1960 in Squaw Valley bei den VIII. Olympischen Winterspielen statt. Seit 1992 haben auch Biathletinnen die Möglichkeit, bei Winterolympiaden Medaillen zu erringen.
Aufgrund des hohen Zeitaufwandes dieser Kombinationssportart rekrutiert sich das Sportlerkollektiv aus professionellen und semiprofessionellen Aktiven mit meist langjähriger Erfahrung im Biathlon-
oder Langlaufsport. Aus der Nähe zum Skilanglauf ergeben sich die auftretenden Verletzungs- und Beschwerdemuster.

Akute sportartspezifische Verletzungen

Akute Traumen sind im Vergleich zu anderen Sportarten seltene Ereignisse. Die Angaben in der Literatur (meist bezogen auf Skilanglauf) schwanken zwischen 0,5 und 5,5 Ereignissen auf 1000 Sportler pro Skilanglauf-Tag. Dies resultiert aus dem niedrigen Gefahrenpotenzial und aus dem fehlenden Breitensportcharakter mit Verletzungen ungeübter Aktiver.


©Wüstenfeld

Schussverletzungen traten im Verlauf der letzten Jahrzehnte nur in Einzelfällen, meist im Rahmen von Unfällen auf. Trotz des kleinen Waffenkalibers war es jedoch zu Verletzungen mit letalen Ausgängen gekommen, was wiederholt in den vergangenen Jahren zu einer deutlichen Verschärfung der Sicherheitsrichtlinien im Regelwerk geführt hat. Dadurch wurde eine weitere Risikominimierung erreicht.

Verletzungen während der auf Ski durchgeführten Trainings und Wettkampfeinheiten sind wesentlich seltener als Verletzungen in den Vorbereitungsphasen außerhalb der Wintersaison. Hier werden die hohen Trainingsumfänge zu Fuß, auf dem Straßenrennrad, dem Mountainbike oder dem Haupttrainingsgerät Skiroller absolviert. So erlitt z.B. der bekannte deutsche Biathlet Erik Lesser beim Sturz mit dem Mountainbike eine Clavikulafrakutur, die eine erhebliche Einschränkung des Sommertrainings nach sich zog. Das Gefahrenpotenzial für Verletzungen beim Skirollern ist vergleichbar mit dem beim Inlineskaten. Viele Verletzungen in der Vorbereitungsperiode resultieren jedoch auch aus sportartunspezifischen Trainingsmaßnahmen, zum Beispiel bei Spielsportarten.

Trainings- und Wettkampfeinheiten auf Langlaufski bergen zumeist sturzbedingte Verletzungsgefahren mit Prellungen, sowie Distorsionen mit Gelenkbinnenschädigungen im Bereich der Hände, der oberen Sprunggelenke und der Kniegelenke. Frakturen der Extremitäten oder im Bereich der Wirbelsäule und des Thorax sind sehr selten. Intensive Trainingseinheiten sind zum Teil von einer erhöhten Muskelverletzungsgefahr mit Zerrungen und Faserrissen begleitet.

Die Therapie der genannten Verletzungen umfasst neben dem gesamten Spektrum der traumatologischen Akutversorgung die Physiotherapie mit ergänzender balneo-physikalischer Therapie, die Orthesenversorgung und auch die interventionelle Schmerztherapie. Operative Eingriffe auf Grund von Skilanglauf/Biathlon-spezifischen Verletzungen sind insgesamt äußerst selten. Sie sind jedoch neben den absoluten Indikationen im Hochleistungsbereich im Gesamtkonzept zur Minimierung der Ausfallzeiten abzuwägen.

Sportartspezifische Überlastungsbeschwerden

Die Gesamtbelastungszeit im Biathlon entspricht in Wettkämpfen denen anderer olympischer Ausdauerdisziplinen mit einer Spannbreite von ca. 17 Minuten (Staffelwettkämpfe, Frauen) bis maximal eine Stunde (Einzelwettkämpfe der Männer). Die Trainingszeitbelastungen sind dagegen sehr hoch und können bei 25-30h/Woche liegen. Im Spitzensportbereich zeigen sich daraus resultierende Überlastungs- und Fehlbelastungssymptome. Dabei stehen akute und chronische Muskeldystonien, Insertionstendinopathien, Tendinitiden und Tendovaginitiden im Vordergrund. Knochenhautreizungen vor allem der unteren Extremitäten beispielsweise durch Schuhprobleme oder muskuläre Fehlbelastung werden häufig beobachtet.

Es finden sich inhomogen verteilte Beschwerdemuster im Bereich der oberen Extremität inklusive Händen und Schultergürtel, der Wirbelsäule im Bereich des lumbosakralen Überganges, der unteren Extremität mit Knie- und Sprunggelenken wie auch des Fußes. In Abhängigkeit von der Trainingsintensität und -akzentuierung ist neben der Technikkorrektur meist auch die ärztliche beziehungsweise physiotherapeutische Betreuung zur Behebung muskulärer Dysbalancen notwendig.


©Wüstenfeld

Insbesondere bei eisigen Streckenverhältnissen, bei denen eine vermehrte Stabilisierung des Skis durch Ausgleichsbewegungen der Muskulatur des Unterschenkels notwendig wird, kommt es bei einigen Athleten zum Auftreten eines funktionellen Kompartmentsyndroms des Tibialis anterior. Dieses äußerst schmerzhafte Ereignis führt nicht selten zur Aufgabe des Wettkampfes. Die Therapie ist schwierig und beinhaltet neben umfänglicher physiotherapeutischen Maßnahme die Veränderung der Schuh- und Bindungsposition, ggf. mit Materialwechsel die Analyse und Therapie von muskulären Dysbalancen und Haltungsschwächen der muskulären Kette von Fuß-Knie-Hüfte-Lendenwirbelsäule. Der operative Ansatz mit Faszienspaltung des Musculus tibialis anterior, der in anderen europäischen Ländern häufiger favorisiert wird, scheint im Vergleich zur konservativen Therapie keine besseren Heilungschancen zu bieten, muss jedoch als ultima ratio Therapie mit in Erwägung gezogen werden.

Durch die Entwicklung neuerer Schuh- und Bindungssysteme mit neueren, festeren Werkstoffen (meist Carbon), kommt es in jüngerer Zeit häufiger zu Reaktionen des Periostes, die durch eine hohe lokale Druckbelastung bedingt sind. Hier muss frühzeitig eingegriffen werden, um eine Chronifizierung der Beschwerden, die bis zu einer äußerst schmerzhaften ossären Kallusbildung gehen kann, vorzubeugen. Durch schuhorthopädische Korrekturen mit Reduktion des lokalen Drucks, ggf. auch Schuhmodelwechsel, lässt sich das Problem effektiv beheben. Im akuten Fall kann eine lokale Infiltrationstherapie notwendig sein.

Um den Vortrieb im Langlaufsport zu gewährleisten, wird der Oberkörper in einer Beugebewegung gegen die unteren Körperpartien bewegt und dann in eine Hyperextensionsposition aufgerichtet. Die zu entfaltende Kraft korreliert mit der Ausnutzung des Beuge-/ Streckungszyklus. Diese Bewegung führt vor allem im Skilanglauf bei sehr hohen Wiederholungszahlen zu einer vermehrten Krafteinwirkung auf die Bewegungssegmente der Lendenwirbelsäule und des lumbosakralen Überganges. Hier sind akute Beschwerden wie auch chronisch degenerative Veränderungen zu beobachten. Im Vergleich zum Skilanglauf, wo zu gleichberechtigten Teilen Wettkämpfe im für die LWS belastenderen klassischen Laufstil und der Skatingtechnik ausgetragen werden, ist im Biathlon aufgrund der alleinig durchgeführten Skatingtechnik mit einer geringeren Frequenz an Beschwerden und Langzeitfolgen zu rechnen.

Aus der alleinigen Anwendung der Skatingtechnik im Biathlon ergeben sich jedoch im Vergleich zum Skilanglauf häufiger Beschwerdebilder im Bereich der Brustwirbelsäule, da viele Athleten einen bevorzugten „Führarm“ in der Ausübung der Skatingtechnik haben. Dies führt über einen längeren Zeitraum zu z.T. erheblichen muskulären Seitendifferenzen, die Beschwerden im Bereich der autochtonen Muskulatur der BWS nach sich ziehen. Hier muss zum einen im allgemeinen Ergänzungstraining auf ein konsequentes Beheben von muskulären Dysbalancen geachtet werden. Ebenso muss der Athlet im sportartspezifischen Training einen häufigen Wechsel der Führhand unter Betonung der schwächeren Führarmseite einhalten.

Internistische Erkrankungen

Sportartspezifisch kommt es zu einer ausgeprägten Exposition mit kalter und sehr kalter Luft in der winterlichen Umgebung. Bei der gleichzeitig belastungsbedingt hohen Ventilationsrate, besteht in der leistungssportlichen Ausübung des Biathlonsports, ein großes Risiko der Reizung der Schleimhaut der oberen Atemwege. Dies führt bei Biathleten gehäuft zu entzündlichen Veränderungen der Schleimhaut im Bereich des Nasen-Rachenraumes, des Kehlkopfes und der oberen Luftwege.
Klinische Symptome von Erkältungskrankheiten wie Husten, Halsbeschwerden, Schnupfen und Nasennebenhöhlenbeschwerden stellen die häufigste Ursache der ärztlichen Konsultation im Biathlon dar. Zur effektiven Vorsorge ist daher eine sehr gute und umfangreiche Verhaltensschulung der Athleten wichtig. Wichtige prophylaktische Maßnahmen beinhalten sämtliche Formen der „Schleimhautpflege“ wie großzügige Trinkmenge (vorzugsweise Tees), Nasenspülungen, Inhalationen und infektionsprophylaktische Maßnahmen wie häufiges Händewaschen, „meiden großer Menschenansammlungen in der Wettkampfsaison“, sofortiger Kleiderwechsel nach Belastungen und Isolierung von erkrankten Athleten.

Die Therapie der in der Regel viral bedingten Erkrankungen ist im Wesentlichen symptomatisch orientiert. Bewährt hat sich auch hier der Einsatz von Nasenspüllösungen, Inhalationen, Lutschpastillen und Phytopharmaka. Medikamentös wird durch Einsatz von hochdosiertem Vitamin C, Zink und lokal antiseptischen Lösungen eine günstige Beeinflussung des Krankheitsverlaufes angestrebt.
Der Einsatz von antiviralen Präparaten ist im Allgemeinen nicht sinnvoll. Ebenso ist der Einsatz von Antibiotika aufgrund der in der Regel zugrundeliegenden viralen Infektion eine eher seltene Behandlungsoption und bleibt in der Regel der Therapie einer bakteriellen Superinfektion vorbehalten.

Übrige internistische Krankheitsbilder sind durch die insgesamt günstige Beanspruchung des kardiovaskulären Systems und positive Auswirkung der Belastung auf den Gesamtorganismus als selten einzustufen. Ebenso ergeben sich aus der Ausübung des Ausdauersports im Vergleich zu anderen Sportarten keine gehäuften kardialen Erkrankungen wie z.B rhythmologische Auffälligkeiten oder myokardial entzündliche Veränderungen.


Laktatabnahme / ©Wüstenfeld

Belastungsinduzierte Atembeschwerden

Die vermehrte Schleimhautreizung der Atemwege durch die häufige intensive Ventilation von kalter und sehr kalter, sowie auch trockener Luft führt bei nordischen Skisportlern häufiger zu belastungsbedingten Atembeschwerden im Sinne eines hyperreagiblen Bronchialsystems, („exercise induced bronchospasm“ – EIB).
Bei Vorliegen einer EIB ist eine frühzeitige antiinflammatorische Therapie mit inhalativen Glukokortikosteroiden angezeigt um eine Progredienz der Erkrankung zu vermeiden. Symptomatisch kann diese zudem mit einem ß2-Mimetikum kombiniert werden, welche z.B. auch als kurzwirksame ß2-Mimetika unmittelbar vor intensiven Belastungen zur Prophylaxe von Anfällen eingesetzt werden können. Der Einsatz von ß2-Mimetika bei Athleten ist prinzipiell durch die Liste der verbotenen Substanzen und Methoden der WADA verboten, jedoch besteht eine Sonderregelung für die inhalative Anwendung von Salbutamol, Salmeterol und Formoterol welche für die Behandlung einer EIB/Asthmas bis zu einer definierten Maximaldosierung zugelassen sind und nur im Falle von Anti-Doping-Kontrollen angegeben werden müssen. Gleiches gilt für die inhalativen Glukokortikosteroide.

Ärztliche Betreuung von Biathleten

Aufgrund der hohen Professionalität der Sportler und dem damit assoziierten, relativ niedrigen Risiko für akute Verletzungen ist eine traumatologische Absicherung direkt vor Ort bei Biathlonwettkämpfen nur für die jeweilige Gesamtveranstaltung (Rennarzt) notwendig. Eine entscheidende Rolle im verbandsärztlichen Betreuungskonzept für den Biathlonsport spielt die interdisziplinäre Komponente. Neben dem betreuenden Mannschaftsarzt, muss ein gutes Netzwerk von konservativen Orthopäden, Internisten und chirurgisch erfahrenen Orthopäden vorgehalten werden. In der Vor-Ort-Betreuung bei Trainingslagern und Wettkampfmaßnahmen stellen Infekte des oberen Respirationstraktes bei weitem die häufigste Behandlungsindikation dar. Der Präventionsschulung und Anleitung der Sportler und Trainer im Rahmen der sportmedizinischen Eignungs- und Saisoneingangsuntersuchungen kommt ebenfalls eine besonders wichtige Bedeutung zu. Um chronische Krankheitsverläufe zu vermeiden, ist eine frühzeitige Intervention mit konservativen Therapieformen zwingend erforderlich und die enge Zusammenarbeit mit den zuständigen Physiotherapeuten essentiell.

Die Autoren

Dr. med. Jan Wüstenfeld ist Ärztlicher Mitarbeiter im Fachbereich Sportmedizin am Institut für Angewandte Trainingswissenschaft, Leipzig. Zusätzlich arbeitet er als Leitender Disziplinarzt der Deutschen Biathlon-Nationalmannschaft.

Prof. Dr. med. Bernd Wolfarth ist Ordinarius für Sportmedizin an der Humboldt-Universität zu Berlin. Er ist Leiter der Abteilung Sportmedizin der Charité Universitätsmedizin Berlin und Leiter des Fachbereiches Sportmedizin am Institut für Angewandte Trainingswissenschaft, Leipzig. Darüber hinaus arbeitet er als Leitender Verbandsarzt des Deutschen Skiverbandes und ist Leitender Olympiaarzt des Deutschen Olympischen Sportbundes.

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