Sehr geehrte Damen und Herren,
im Februar werden in Innsbruck/Igls die Weltmeister im Zweier- und Vierer-Bob ermittelt. Nach den Enttäuschungen im olympischen Eiskanal von Sotschi vor zwei Jahren wollen die deutschen Piloten um Francesco Friedrich aus Pirna das angekratzte Image aufpolieren. Dabei geht es im Eiskanal nicht nur um schnelle Kufen und modernstes Material. Vor allem beim Start sind die athletischen Voraussetzungen entscheidend – und wie das Team beim Sprung in den Bob sowie bei der rasanten Fahrt auf eisigem Untergrund harmoniert. Im ersten GOTS-Newsletter des neuen Jahres beschäftigt sich Dr. Christian Schreiber u.a. mit den Risiken, akuten Verletzungen und den Möglichkeiten der Prävention im Bobsport.
Mit freundlichen Grüßen
Andreas Bellinger, presse@gots.org
Vom 16. bis 18. Juni 2016 findet in München der 31. Jahreskongress der Gesellschaft für Orthopädisch-Traumatologische Sportmedizin (GOTS) statt. Ein Hauptthema des Kongresses wird die Erfassung und Überwachung von Sportverletzungen sein. GOTS-Ehrengast Professor Roald Bahr und der frühere GOTS-Ehrengast Professor Lars Engebretsen aus Norwegen werden über ihre Erfahrungen auf dem Gebiet der Verletzungsüberwachung und -prävention berichten, und den Nutzen der Erkenntnisse der Epidemiologie von Sportverletzungen auf die tägliche Praxis mit sportlich aktiven Patienten erläutern. Weitere Informationen finden Sie auf der Kongresswebsite unter www.gots-kongress.org
Bobfahren aus sportmedizinischer Sicht
Im Februar finden die Weltmeisterschaften im Bob und Skeleton in der Tiroler Olympiaregion Innsbruck/Igls statt. Dreimal schon brannte das olympische Feuer über der Stadt im Westen Österreichs – bei den Olympischen Spielen 1964 und 1976 sowie bei den ersten Olympischen Jugendspielen 2012. Im Eiskanal von Igls werden vom 08. bis 21. Februar sechs Titel vergeben, wobei der Wettbewerb um die große Glaskugel im Vierer-Bob der Männer das Highlight sein wird. Zusammen mit den Skeletonathleten wird auch wieder ein Team-Wettbewerb ausgetragen und erstmals ein Testrennen im Vierer-Bob der Frauen.
Die Saison wurde vor Weihnachten mit den drei Weltcups in Deutschland (Altenberg,Winterberg und Königsee) gestartet – und wird in diesem Jahr noch einen „Nachschlag“ bekommen. Im Anschluss an die Weltcup-Serie werden die besten Teams ins Land der Olympischen Winterspiele 2018 nach Südkorea reisen. Dort steht die Homologierung des olympischen Eiskanals In Pyeongchang auf dem Programm.
Anforderungs- und Belastungsprofil
Grundlage für eine gute Fahrt im Eiskanal ist der Start. Die Mannschaft schiebt den Bob möglichst schnell bis zu 15 Metern auf zwei Prozent Gefälle an, bevor Pilot und Anschieber in den Bob springen. Nach 50 Metern wird die Startzeit gemessen. Der Pilot steuert den Bob, möglichst auf der Ideallinie, den Eiskanal hinunter ins Ziel. Mit hohen Geschwindigkeitsverlusten gehen Bandenberührungen und ein Abheben des Bobs vom Eis einher. Der Schlussmann (Bremser) ist nach Überqueren der Ziellinie mit zwei Handbremshebeln für das Bremsen des Bobs zuständig – während der Fahrt wird heutzutage nicht mehr gebremst!
Die besonders hohen athletischen Anforderungen haben dazu geführt, dass die Positionen der Anschieber und Bremser immer häufiger von Leichtathleten besetzt werden. Die idealen Voraussetzungen werden durch gezieltes Maximalkrafttraining mit Schnellkrafttraining kombiniert, um schnelle Abrisszeiten beim Start zu erreichen. Koordinationstraining und Verbesserung der Anschubtechnik runden das Ganzjahrestrainingsprogramm ab.
Weltmeister am Start: Francesco Friedrich, Jannis Baecker, Martin Putze, Thorsten Margis.
Akute Verletzungen
Die Sportart an sich ist wenig verletzungsträchtig. Häufig treten allerdings bereits am Start Weichteilverletzungen auf. Das kann durch Ab- und Ausrutschen beim Einsteigen in den Bob passieren oder auch durch die Spikes an den Schuhen der Mannschaftskollegen. Während der Fahrt „verschwinden“ die Anschieber nahezu vollständig im Bob und verbringen die etwa 60 Sekunden bis zum Ziel in stark nach vorn gebeugter Körperhaltung. In dieser Position ist die Aerodynamik zwar besonders gut, aber die gesamte Wirbelsäule ist dadurch starken Belastungen ausgesetzt, so dass akute Schmerzattacken ausgelöst werden können.
Das hohe Gewicht der Sportgeräte schon ohne die Athleten (Zweier-Bob: 170 Kilo – Vierer-Bob: 210 Kilo), die harten Materialien und die teils rauen Bedingungen der Umgebung können beim Transport, der Vorbereitung oder auch im Wettkampf zu stumpfen Traumata führen. Quetschungen an Händen und Fingern, Nagelhämatome, aber auch Prellungen und Hämatome an den Extremitäten sind keine Seltenheit. Die zum Anschieben des Schlittens auf dem Eis erforderlichen Spikes führen bei Kontakt mit den Teamkollegen während der Startphase vor allem beim Vierer-Bob zu Risswunden an Beinen und Händen, die heftig bluten können.
Im Falle eines Sturzes, wenn der Bob während der Fahrt im Eiskanal umkippt, versucht der Athlet, möglichst tief im Bob zu „verschwinden“, um nicht mit dem Kopf auf das Eis zu schlagen. Die enorm hohen Kräfte haben discoligamentäre Verletzungen meist der Halswirbelsäule, Kompressionsfrakturen der Lendenwirbelsäule und Gehirnerschütterungen zur Folge. Dies ist abzuklären. Längere Kontaktzeiten von Schultern oder anderen Körperteilen mit dem Eis führen zu Verbrennungen an exponierten Stellen mit entsprechender Narbenbildung – oder machen sogar eine Operation notwendig. Schutzausrüstungen sind empfohlen und können helfen, das Risiko solcher Verletzungen zu minimieren.
Das Friedrich-Team „versinkt“ tief im Bob auf der Jagd nach der Bestzeit. Fotos: BSD/Reker
Die aktuelle Diskussion um das Thema Concussion (Gehirnerschütterung) hat auch den Bobsport erreicht. Zur Verbesserung der Objektivität nach einer Concussion hat sich der Weltverband IBSF entschlossen, ein standardisiertes Messinstrument verpflichtend einzuführen. Dafür wird ein 20-minütiger Baseline-Test am heimischen Computer zur Beurteilung der cerebralen Belastung und Leistungsfähigkeit durchgeführt.
Nach einem verdächtigen Sturz, einer ungewöhnlichen Kollision oder bei auftretenden Symptomen kann so über die Bahn- oder Mannschaftsärzte ein Vergleichstest durchgeführt werden, und das Verhältnis der Messergebnisse mit den klinischen Befunden zur Beurteilung einer Erlaubnis „return-to-slide“ (Lizenz) herangezogen werden. Damit haben auch Athleten aus allen Teilen der Welt die Möglichkeit, von den Erfahrungen der modernen Wissenschaft und Medizin zu profitieren.
Gelegentlich rutscht der sogenannte Bremser aus dem Bob heraus. Der Athlet muss dann möglichst schnell die Bobbahn verlassen, um nicht von seinem eigenen Bob erfasst oder verletzt zu werden, falls der zum tiefsten Punkt der Bahn zurückrutscht. Zu tödlichen Verletzungen kommt es dank der konstanten Optimierung der Bahnen und Bobs sowie einem gezielten Fahrtraining nur noch sehr, sehr selten. Die meisten Verletzungen treten im Training auf. Vor allem beim Ausgleichssport wie etwa beim Fußball spielen, das der Verbesserung der Koordination dienen soll.
Überlastungsschäden
Weitere Verletzungs- und Überlastungsmuster entsprechen denen der Leichtathletik. Überlastungen der Sehnenansätze und der belasteten Knorpelanteile in den Kniegelenken sind möglich und müssen konsequent diagnostiziert und austherapiert werden. Aufgrund der hohen Belastung der Hals- und Lendenwirbelsäule ist hier auftretenden Beschwerden besondere Beachtung zu schenken. Eine gezielte Abklärung der Sportfähigkeit ist zur Vorbeugung von dauerhaften Schäden angezeigt.
Die im Rahmen der großen Multicenter-Studie RanRücken innerhalb des MiSpEx (Medicine in Spine Exercise)-Netzwerks gewonnenen Erkenntnisse der Funktionsdiagnostik und die Ableitung von spezifischen Kräftigungs- und Stabilisationsübungen werden direkt in die Praxis umgesetzt.
Beim Anschieben des Bobs sind schnelle und kräftige Leichtathleten im Vorteil.
Prävention
Bei den auftretenden Beschwerden und Überlastungsschäden der unteren Lendenwirbelsäule ist vor allem eine ausreichende Rumpfstabilität wichtig. Die gezielte Trainingssteuerung beginnt seit einigen Jahren schon bei den Jahresgrunduntersuchungen, wo bereits Kraft- und sensomotorische Messungen stattfinden. Der muskuläre Zustand des gesamten Körpers ist das entscheidende Kapital der teils schon etwas älteren Sportler. Deshalb sollte das sportartspezifische Trainingsprogramm konsequent um ein ausgleichendes Sport- und Rehabilitationsprogramm ergänzt werden.
Über den Autor:
Dr. med. Christian Schneider ist Chefarzt des Sportorthopädischen Instituts der Schön Klinik in München Harlaching. Er ist leitender Verbandsarzt des Bob- und Schlittenverbandes Deutschland eV (BSD), Vorsitzender der Verbandsärzte Deutschland eV, GOTS-Vorstandsmitglied und Mitglied der medizinischen Kommission des Deutschen Olympischen Sportbundes (DOSB).
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