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Gesellschaft für Orthopädisch-Traumatologische Sportmedizin

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Faszien

Faszien

Sehr geehrte Damen und Herren,

Faszien können Beschwerden auslösen, deren Ursache auf den ersten Blick unklar sind. Eine Methode zur Behandlung der Faszien ist das sogenannte “Myofascial re-lease” mit Hilfe von Foam-rolling. Über die Behandlung von Beschwerden hinaus soll die Eigenbehandlung der Faszien mittels Foam rolling die sportliche Leistungsfähigkeit steigern, das Aufwärmen unterstützen sowie zu einer verbesserten Regeneration und Tonussenkung der Muskulatur beitragen.

Im aktuellen GOTS-Newsletter beschreiben Prof. Dr. Jürgen Freiwald und seine Co-Autoren, Dr. Christian Baumgart und Dr. Matthias W. Hoppe, welche Vor- und Nachteile Foam-rolling bieten, welche Typen von Foam-rolling im Angebot sind und warum es schwierig ist, im Pro und Contra der Anwendung eine Empfehlung zu geben.

Mit freundlichen Grüßen,
Ihr Andreas Bellinger, GOTS-Pressesprecher

Der Jahreskongress der Gesellschaft für Orthopädisch-Traumatologische Sportmedizin (GOTS) findet vom 24. bis 26. Mai 2018 in Hamburg erstmals als Deutscher Olympischer Sportärztekongress statt. Die Premiere der dreitägigen Veranstaltung, die in Zusammenarbeit mit der Deutschen Gesellschaft für Sportmedizin und Prävention (DGSP) ausgerichtet wird, trägt den Titel: “Gemeinsam für einen gesunden Sport”. Die Registrierung für den Kongress unter dem Patronat der ESSKA, zu dem mehr als 1.000 Sportärzte, Orthopäden, Traumatologen, Sportwissenschaftler, Bewegungsmediziner, Biologen, Chirurgen, Internisten, Kinderärzte, Sport-Therapeuten und viele andere Experten aus der Gesundheitswirtschaft aus dem In- und Ausland erwartet werden, ist unter www.deutscher-olympischer-sportaerztekongress.de/registrierung/ möglich. Ehrengäste werden der Sportwissenschaftler Ph.D. J. Larry Durstine von University of South Carolina sowie MD Dr. Volker Musahl von University of Pittsburgh sein, der sich auf orthopädische Chirurgie und Sportmedizin spezialisiert hat. Nähere Informationen zu den geplanten Sitzungen und internationalen Session-Highlights an der Universität Hamburg (Edmund-Siemers-Allee 1/Gebäude 20) entnehmen Sie bitte dem aktuellen Pocket-Programm im Anhang dieses GOTS-Newsletters sowie der Kongress-Website www.deutscher-olympischer-sportaerztekongress.de.

Wir möchten Sie zudem auf folgende Veranstaltungen hinweisen:
21. April 2018 in Straubing: Update Sportmedizin – Focus: Laufsport, www.update-sportmedizin.de/
17. – 20. Mai 2018 in Podersdorf: Sportmedizinischer Grundkurs OTP II, www.sinwel.com/gots/otp18/otp-18-main.html
18. – 19. Mai 2018 in Podersdorf: GOTS Young Academy Workshop Podersdorf. Weitere Informationen zu der Veranstaltung, die im Rahmen des Sportmedizinischen Grundkurses OTP II stattfindet und sich im Wesentlichen an Studenten richtet, finden Sie im Anhang dieses Newsletters.
05. – 08. Juni 2018 in Regensburg: 18. Regensburger Sporttage, www.uni-regensburg.de/medizin/orthopaedie/sporttage/

Foam-rolling: Myofasziale Eigenbehandlung in Sport und Therapie

Myofasziale Eigenbehandlungen mittels Foam-rolling (FR) erfreuen sich zunehmender Beliebtheit, nicht nur in der Physiotherapie, sondern bis in den Fitness- und Leistungssport. Die versprochenen Wirkungen sind mannigfaltig. Sie beinhalten Leistungssteigerung, Unterstützung beim Aufwärmen sowie verbesserte Regeneration und Tonussenkung der Muskulatur. Die zugrundeliegende Forschungslage ist hingegen lückenhaft und widersprüchlich [1].

Anatomische Aspekte
Es besteht Uneinigkeit, welche Bindegewebstypen zum faszialen Gewebe zählen (z.B. Endo-, Perimysium) und welche nicht (z.B. Sehnen, Aponeurosen, Bänder), was die Kommunikation zwischen Forschern und Praktikern erschwert [2, 3].

Die (faszialen) Bindegewebe werden unterschiedlich klassifiziert. Ein Ansatz besteht darin, Bindegewebe in vier funktionale Kategorien zu unterteilen (d.h. dynamisches, passives, faszikuläres und kompressives Bindegewebe) [4]. Andere Autoren verwenden andere Kategorien und Definitionen für fasziales Bindegewebe. Sie unterscheiden in “dense and non-dense (areolar) connective tissue”, “superficial fascia”, “deep fascia”, “intermuscular septa”, “interosseal membrane”, “periost”, “neurovascular tract”, “epimysium”, “perimysium”, “endomysium” sowie “intra- and extramuscular aponeurosis” [2].

Ein weiteres Problem besteht darin, dass viele Behandlungs- und Trainingskonzepte auf der Annahme von sechs myofaszialen Ketten (myofasziale Leitbahnen) basieren [5]. Es besteht jedoch nur für drei Leitbahnen Evidenz [6]. Aufgrund der widersprüchlichen Annahmen und Befunde, ist es demnach schwierig, bei der Anwendung von FR zu eindeutigen Aussagen und Empfehlungen zu kommen.

Produkte
Für das Foam-rolling werden verschiedene Produkte verwendet. Sie verfügen über unterschiedliche Eigenschaften etwa in Bezug auf die Oberflächenbeschaffenheit sowie den Härtegrad und den Durchmesser. Wenn demnach von FR gesprochen wird, müssen auch die verwendeten Rollen benannt bzw. festgelegt werden (Abbildung 1).

Abb.1: Verschieden Typen der Foam Rollers: blackroll.de (links); sport-thieme.de (Mitte oben); suprfit.de (Mitte unten); togu.de (rechts).

Biomechanische Untersuchungen und Kontraindikationen
Untersuchungen zeigen, dass FR zu einer hohen Druckbelastung des darunterliegenden Gewebes führt [7]. Der gemessene Druck entspricht etwa dem 10-fachen der maximal zulässigen Kompressionsklasse 4 – sowie dem doppelten Druck, der zur vollständigen Okklusion notwendig ist [Übersicht in 8]. Da hohe Druckbelastungen sowohl auf die Haut als auch auf Gefäße und Nerven wirken, sind Kontraindikationen zu berücksichtigen. Absolute Kontraindikationen des Foam-rolling sind unter anderem die Neigung zu Krampfadern, Hämophilie, periphere Neuropathien, Gefäßerkrankungen, Thrombosen, Wirbelgleiten und operativ fixierte Wirbelkörper.

Untersuchungen zur sportlichen Leistungsfähigkeit
Durch Foam-rolling soll die sportliche Leistungsfähigkeit gesteigert werden. Auch an dieser Stelle sind die Befunde widersprüchlich: Die Mehrheit der Untersuchungen zeigen durch FR keine leistungssteigernden Effekte. Während die Beweglichkeit kurzfristig positiv beeinflusst wird, zeigt FR in Bezug auf die Kraftentwicklung indifferente Ergebnisse [9]. Auf die Sprunghöhe bezogen, zeigen unsere Untersuchungen eine hochsignifikante Steigerung der Vertikal-Sprunghöhe nach einem Aufwärmen auf dem Fahrradergometer, hingegen keinen leistungssteigernden Effekt nach FR (Abbildung 2).

Abb.2: Effekte auf die Sprunghöhe: Das Foam-rolling wurde bei 20 Sportstudierenden am Oberschenkel (OS) und am Unterschenkel (US) nach Herstellerangaben (BlackRoll) durchgeführt. Die Vergleichsgruppe (n=20) führte ein Aufwärmen auf dem Fahrradergometer für zehn Minuten bei einer RPE von 12-14 – also bei mittlerer Anstrengung auf der Borg-Skala – durch. Folgend wurden die Sprunghöhen (counter movement jump) auf Kraftmessplatten gemessen. Die Rubrik * zeigt eine statistische Differenz von p ≤.001 [Details in 10].

Regeneration
Zur Regeneration durch Foam-rolling gibt es nur wenige Befunde [11]. Die meisten Untersuchungen beziehen sich auf die physiologischen Parameter der Regeneration (u.a. Blutwerte) sowie die subjektiven Schmerzangaben nach sogenanntem Muskelkater. FR kann zur schnelleren subjektiven Regeneration beitragen; die messbaren physiologischen Parameter der Regeneration, wie beispielsweise der Cortisolspiegel, bleiben nach sportlichen Belastungen durch das FR unbeeinflusst [12].

Zusammenfassung und Ausblick
Zum jetzigen Zeitpunkt ist es schwierig, eine Empfehlung für oder gegen die Anwendung von FR zu geben. Wer FR nutzen möchte, sollte vor jeder Anwendung das eigene Trainings- bzw. Therapieziel genau festlegen. Ob dieses durch FR anschließend erreicht wurde, lässt sich dann einfacher überprüfen. Jeder Anwender sollte sich vorher durch qualifizierte unabhängige Fachleute beraten lassen, ob in der individuellen Situation die Sicherheit und Wirksamkeit vom FR gegeben ist. Ansonsten sollten die Anwender alternative evidenzbasierte Verfahren in Betracht ziehen, zumal mittlerweile auch die Hersteller darauf verweisen, dass die Produkte bei den jeweiligen Übungen auf eigenes Risiko verwendet werden.

Über die Autoren:

Univers. Prof. Dr. Jürgen Freiwald M.A. ist Leiter des Arbeitsgebietes Bewegungs- und Trainingswissenschaft und des Forschungszentrums für Leistungsdiagnostik und Trainingsberatung an der Bergischen Universität Wuppertal.

Dipl.-Sporting. Dr. rer. nat. Christian Baumgartist Leiter des Forschungslabors des Arbeitsgebietes Bewegungs- und Trainingswissenschaft und des Forschungszentrums für Leistungsdiagnostik und Trainingsberatung an der Bergischen Universität Wuppertal. Er verfügt über umfangreiche Erfahrungen als Gutachter für nationale und internationale Fachzeitschriften. Die Schwerpunkte seiner Arbeit liegen in der Leistungsdiagnostik, der Prävention und der Rehabilitation.

Dr. rer. nat. Matthias W. Hoppe hat die wissenschaftliche Leitung in der Klinik für Orthopädie, Unfall- und Handchirurgie in Osnabrück inne und leitet die Forschung der Leistungsphysiologie im Arbeitsgebiet Bewegungs- und Trainingswissenschaft an der Bergischen Universität Wuppertal.

Literatur

  1. Freiwald, J., et al., Faszien – Bedeutung in Sport und Therapie. Anatomische, physiologische, biomechanische Grundlagen von Therapie und Training der Faszien, in Muskel- und Sehnenverletzungen, M. Engelhardt and F. Mauch, Editors. 2017, Vopelius: Jena. p. 85-106.
  2. Langevin, H.M. and P.A. Huijing, Communicating about fascia: history, pitfalls, and recommendations. Int J Ther Massage Bodywork, 2009. 2(4): p. 3-8.
  3. Huijing, P.A., Muscular force transmission necessitates a multilevel integrative approach to the analysis of function of skeletal muscle. Exerc Sport Sci Rev, 2003. 31(4): p. 167-75.
  4. Kumka, M. and J. Bonar, Fascia: a morphological description and classification system based on a literature review. J Can Chiropr Assoc, 2012. 56(3): p. 179-91.
  5. Myers, T.W., Anatomy Trains – Myofasziale Leitbahnen für Manual- und Bewegungstherapeuten. 3 ed. 2015, München: Urban & Fischer.
  6. Wilke, J., et al., What Is Evidence-Based About Myofascial Chains: A Systematic Review. Arch Phys Med Rehabil, 2016. 97(3): p. 454-61.
  7. Curran, P.F., R.D. Fiore, and J.J. Crisco, A comparison of the pressure exerted on soft tissue by 2 myofascial rollers. J Sport Rehabil, 2008. 17(4): p. 432-42.
  8. Baumgart, C., et al., eds. Massagerollen – Segen oder Fluch? Sporttechnologie zwischen Theorie und Praxis VI ed. K. Witte and J. Edelmann-Nusser. 2015, Shaker: Aachen. 52-60.
  9. Smith, J.C., B. Pridgeon, and M.C. Hall, Acute Effect of Foam Rolling and Dynamic Stretching on Flexibility and Jump Height. J Strength Cond Res, 2018.
  10. Freiwald, J., et al., Foam-Rolling in sport and therapy – Potential benefits and risks: Part 2 – Positive and adverse effects on athletic performance. Sports Orthop Traumatol, 2016. 32: p. 267-275.
  11. Meyer, T., et al., eds. Regenerationsmanagement im Spitzensport. REGman-Ergebnisse und Handlungsempfehlungen., ed. B.f.S. (Hrsg.). 2016, Strauß: Köln.
  12. Kim, K., et al., Effect of Self-myofascial Release on Reduction of Physical Stress: A Pilot Study. J Phys Ther Sci, 2014. 26(11): p. 1779-81.

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