Gesellschaft für Orthopädisch-Traumatologische Sportmedizin

FIFA Präventionsübungen für Fussball

Die FIFA empfiehlt zehn Übungen mit kräftigenden und koordinativen Inhalten

Belastungen beim Fußball sind stark gestiegen – Kluge Prävention mindert Verletzungsrisiko erheblich

Die Anforderungen im Leistungsfußball sind in den letzten Jahren deutlich gestiegen. Das betrifft weniger den Umfang der Laufbelastungen während der Spiele. Sie sind in den letzten Jahren mit etwa 8 bis 12 Kilometer gleich geblieben. Was sich jedoch verändert hat, sind die Intensitäten und damit das Tempo der jeweiligen Spielaktionen. In den letzten zehn Jahren hat die Anzahl der kurzen Sprints um 30 Prozent zugenommen. Im professionellen Bereich werden je Spiel etwa 160 Sprints absolviert, 70 Prozent der Sprints liegen in der Distanz zwischen einem und zehn Metern.

Eine weitere Veränderung liegt in der Wettkampfhäufigkeit. Durch die Zunahme von Wettspielen ist die Zeit zum zielgerichteten Leistungsaufbau und zur notwendigen Regeneration knapp bemessen. Viele Spieler absolvieren mittlerweile pro Jahr siebzig bis achtzig Spiele – dass ist zu viel. Die am meisten von Verletzungen betroffene Region sind die unteren Extremitäten, insbesondere die Fuß-, Sprung- und Kniegelenke. Als häufigste Verletzungen imponieren Kapsel-Bandverletzungen, es folgen Muskelverletzungen, meist Muskelzerrungen sowie Prellungen, Brüche und Ausrenkungen.

Um Verletzungen vorzubeugen, scheinen Einzelmaßnahmen wie zum Beispiel Dehnungen eine eher untergeordnete Rolle zu spielen. Angesichts der Komplexität für Verletzungsursachen ist ein ganzes Maßnahmenbündel notwendig. Präventionsprogramme müssen daher sowohl personenbezogene Faktoren (intrinsische Faktoren) als außerhalb der Person gelegene Faktoren (extrinsische Faktoren) wie die Ausrüstung, die Spielfläche oder die Trainingsmethodik berücksichtigen. Dazu gehören:

Bei allen orthopädischen, internistischen und trainingswissenschaftlichen Untersuchungen muss darauf hingewirkt werden, dass die Ergebnisse nicht in einem Computer “versacken”, sondern dass auf den Ergebnissen aufbauend individuelle und mannschaftsbezogene Therapie- und Trainingspläne erstellt und umgesetzt werden. Für die Verletzungsprophylaxe ist ein guter Trainingszustand von Bedeutung. Besondere Aufmerksamkeit haben in den letzten Jahren Trainingsmaßnahmen gefunden, die ergänzend zum gewohnten Fußballtraining angewendet werden. So empfiehlt der Fußballweltverband FIFA auf der Basis vielfältiger Forschungen zehn Übungen. Sie stellen einen Mix von kräftigenden und koordinativen Inhalten dar. Insbesondere die Rumpf- und die hintere Oberschenkelmuskulatur werden gekräftigt sowie die Beinachse und Sprunggelenke durch koordinativ akzentuierte Übungen stabilisiert. Erstaunlich ist die Tatsache, dass zur Prävention nicht eine Dehnungsübung empfohlen wird. Die Wirksamkeit der Übungen konnte mittlerweile über eine Verminderung der Verletzungsquoten in beeindruckender Art und Weise belegt werden.

Besondere Aufmerksamkeit muss in Zukunft der Re-Integration von verletzten Spielern gewidmet werden. Die Statistiken belegen eindeutig, dass sie nach einer Verletzung einem mehrfach erhöhtem Risiko der Wiederverletzung ausgesetzt sind. Untersuchungen an der Bergischen Universität in Wuppertal belegen, dass es nach Kapsel-Bandverletzungen zur Reorganisation des neuro-muskulären Systems kommt – und das benötigt Zeit. Typischerweise verletzen sich die Spieler dann, wenn die Kraft und insbesondere die Koordination nachlassen. Diese Sichtweise erklärt die vielen Muskelverhärtungen oder gar Muskelzerrungen und -risse nach vorheriger Kapsel-Band-Verletzung. Es wird deshalb empfohlen, ehemals verletzte Spieler behutsam an die volle Länge des Spiels heranzuführen, und – je nach Schwere der vorausgegangenen Verletzung – den Spieler zur Halbzeit bzw. bei Eintreten von Ermüdung frühzeitig auszuwechseln.

Ein weiterer Punkt künftiger Bemühungen muss die Prävention der vorderen Kreuzbandverletzungen darstellen; insbesondere im Frauenfußball. Erste Präventionsprogramme, die bei Frauen wie bei Männern im Leistungsfußball durchgeführt wurden, zeigen ein beträchtliches Potential der Verletzungsprävention. Bei Jugendfußballern im Amateur- und Leistungsbereich konnten durch ein präventives Trainingsprogramm die Verletzungen um ein Drittel bis zur Hälfte reduziert werden. Noch extremer waren die Ergebnisse einer Untersuchung zur Prävention von vorderen Kreuzbandverletzungen bei Frauen. Durch ein spezielles präventives Trainingsprogramm konnten die vorderen Kreuzbandrisse um 80 Prozent reduziert werden. “Die Gefahr, dass der Fußballspieler sich verletzt, ist größer geworden. Um so wichtiger ist die Prävention”, sagt Privatdozent Dr. Martin Engelhardt aus Bielefeld, der Präsident der Gesellschaft für Orthopädisch-Traumatologische Sportmedizin (GOTS).

Professor Jürgen Freiwald, Wuppertal, April/Mai 2006

Der Autor arbeitet an der Bergischen Universität Wuppertal. Er leitet den Arbeitsbereich Bewegungswissenschaft. Mittlerweile über 30 Bücher und Buchbeiträge sowie mehr als 250 nationale und internationale Publikationen mit den Schwerpunkten der Prävention und Rehabilitation weisen ihn als einen der profiliertesten Vertreter zur Thematik aus. Professor Dr. Jürgen Freiwald ist seit 2002 Beiratsmitglied der GOTS und unter Freiwald@uni-wuppertal.de sowie unter www.bewegungswissenschaft.uni-wuppertal.de zu erreichen.

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