Gesellschaft für Orthopädisch-Traumatologische Sportmedizin

Drei Wochen bis Sotschi: Rennrodeln aus sportmedizinischer Sicht

Sehr geehrte Damen und Herren,

am 7. Februar werden im russischen Sotschi die 22. Olympischen Winterspiele eröffnet. In diesem Newsletter informieren wir Sie zum aktuellen Sachstand der sportmedizinischen Betreuung in der Disziplin Rennrodeln.

Bereits erschienen sind die Ausgaben zu folgenden olympischen Wintersportarten – alle Inhalte unserer Newsletter sind zur Veröffentlichung und weiteren Verwendung freigegeben:

Hinweisen möchten wir an dieser Stelle an das 16. GOTS-Wintertreffen am 6. Februar 2014 in Basel zum Thema “Knieverletzungen im Sport: Beyond Evidence” und den 15. Jahreskongress der Landesinnung Bayern für Orthopädie-Schuhtechnik vom 25. bis 27. April 2014 in Garmisch-Partenkirchen.

Mit freundlichen Grüßen,
Frank Wechsel und Dr. Wolfgang Schillings, GOTS-PressesprecherÂ

Rennrodeln aus sportmedizinischer Sicht

Vom 7. bis 23.2.2014 finden die 22. Olympischen Winterspiele im russischen Sotschi statt. Im Sliding Center „Sanki“ werden in vier Disziplinen olympische Goldmedaillen an die Rennrodlerinnen und Rennrodler vergeben – erstmals auch im Mannschaftswettbewerb, der „Team-Staffel“. Die bisherige Saison lässt spannende Wettkämpfe zwischen den Nationen und ihren teils jungen Athleten und bekannten Rodellegenden erwarten.

Rennrodeln im olympischen Sinne wird ausschließlich auf Kunsteisbahnen ausgetragen. In den Disziplinen Damen-Einsitzer, Herren-Ein-/Doppelsitzer und seit diesem Jahr auch wieder als Mannschaftswettbewerb „Team-Staffel“ werden die Rennen ausgetragen – es gilt die schnellste Gesamtzeit im Eiskanal zwischen Start und Ziel nach mehreren Durchgängen zu erreichen.

Essenzielle Grundlage für eine gute Fahrt im Eiskanal ist bereits der Start. Dabei kommt es beim explosionsartigen Abzug vom Startbügel zu starken Zugbelastungen der Schultern und insbesondere der Schultereckgelenke, aber auch zu enormen Belastungen der Lendenwirbelsäule durch den gleichen explosiven Übergang aus der Vorspannungs-Kyphose in die Hyperlordose. In der Bahn werden dann Geschwindigkeiten von bis zu 150 km/h und Druckbelastungen bis zu 4G erreicht. Die Ideallinie auf der Fahrt bei aerodynamisch optimierter Fahrlage zu erreichen, ist das Ziel der Athleten.

Die besonders hohen Anforderungen an die Schulterregion und die stabilisierende Muskulatur der Hals- und Lendenwirbelsäule bestimmen das athletische Training. Gezieltes Maximalkrafttraining muss mit Schnellkrafttraining kombiniert werden, um bestmögliche Abrisszeiten beim Start zu erreichen. Koordinationstraining und Halte-/Ausdauertraining der gesamten Rumpfmuskulatur erlauben, die Belastungen gerade auf die den Schlitten frei nach hinten überragende Halswirbelsäule auszugleichen.

Verletzungen beim Rennrodeln
Fahrfehler im Eiskanal führen beim Rennrodeln zu Prellungen und Hämatomen vor allem an den Außenseiten der unteren und oberen Extremitäten – teils entstehen durch die hohen wirkenden Kräfte aber auch Verbrennungen, die bis in tiefere Hautschichten reichen können. Frakturen betreffen vor allem die fünften Mittelfußknochen, aber auch andere knöcherne Anteile von Fuß und Sprunggelenk.

Häufiger als im Wettkampf treten Verletzungen in der Vorbereitung und im allgemeinen Training auf. Hier ist das Fußballspielen und dadurch bedingt die Verletzungen des oberen Sprunggelenks deutlich führend.

Gefahr durch Stürze
Im Falle eines Sturzes sind neben diversen Prellungen auch Frakturen an allen auftreffenden Körperregionen zu beobachten. Der Wirbelsäule sollte dabei immer die größte Aufmerksamkeit gewidmet werden, da es bei vorliegender Instabilität zu einer Querschnittssituation kommen kann. Durch die enorm hohen Kräfte sind discoligamentäre Verletzungen der Halswirbelsäule, Kompressionsfrakturen der Brust- und Lendenwirbelsäule sowie Schädel-Hirn-Traumen abzuklären.

Überlastungsschäden
Die hohe Belastung der Schulterregion beim Startvorgang (und dem entsprechenden Training!) mit Anreißen, Abstoßen und anschließendem „Paddeln“ mit den spikebesetzten Handschuhen führt über Jahre zu Impingement-Syndromen und Arthrosen vor allem im AC-Gelenk und teils zu Rupturen an der Rotatorenmanschette.

An der Lendenwirbelsäule führt der schnelle Wechsel während des Startens aus der Hyperkyphose in eine Hyperlordose zu Extrembelastungen des lumbosakralen Übergangs – häufig finden sich frühzeitige Degenerationen der Bandscheiben und Facettengelenke, aber auch Vorwölbungen bis hin zu Bandscheibenvorfällen.

Auf die Halswirbelsäule wirken während der Fahrt enorme Kräfte, da der Kopf den Schlitten nach hinten frei überragt und damit keine Unterstützungsauflagefläche hat – gemindert durch ein Band, das den Helm am Kinn mit dem Körper verbindet, und die eigene Muskelkraft. In der Folge treten häufig chronische HWS-Beschwerden auf durch Bandscheibenvorfälle, Verschleiß an den Bandscheiben und den Wirbelgelenken sowie durch die resultierenden Einengungen der Nervenwurzeln. Teils sind operative Eingriffe nicht zu vermeiden, die jedoch meist mit sehr gutem Erfolg durchgeführt werden und eine Rückkehr in die sportliche Aktivität ermöglichen können.

Prävention
Ein gutes muskuläres Korsett an allen drei Problemzonen kann lange Zeit Beschwerden verhindern und ist damit notwendiger Bestandteil jeder Trainingseinheit. Die gezielte Trainingssteuerung beginnt seit Jahren bei den Jahresgrunduntersuchungen, wo unter anderem Kraft- und sensomotorische Messungen stattfinden. Der muskuläre Zustand des gesamten Körpers ist das entscheidende Kapital der Sportler, so dass das gezielte Grundtrainingsprogramm konsequent um ein ausgleichendes Sportprogramm ergänzt wird.

Ein besonderer Dank gilt an dieser Stelle dem ehemaligen leitenden Verbandsarzt des BSD, Herrn Dr. Volker Jägemann, der sich über Jahre den Verletzungen der Rodler angenommen hat und durch konsequentes Insistieren Veränderungen in Diagnostik und Trainingsinhalten bewirken konnte.

Tipps für den betreuenden Arzt

Über den Autor:
Dr. Christian Schneider, Leitender Arzt SCHÖN KLINIK Rückeninstitut und Sportmedizin, leitender Verbandsarzt Bob- und Schlittenverband Deutschland e.V., GOTS-Mitglied seit 2000, Vorsitzender Verbandsärzte Deutschland e.V. und Vorstandsmitglied GOTS seit 2012

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