Gesellschaft für Orthopädisch-Traumatologische Sportmedizin

GOTS: Verletzungen beim Handball

GOTS – Pressenewsletter 10.01.2011

Sehr geehrte Damen und Herren,

am Wochenende beginnt in Schweden die 22. Handball-Weltmeisterschaft. In diesem Newsletter betrachten wir die Sportart aus Sicht der Sportmedizin. Alle Texte sind zu Ihrer medialen Verwendung freigegeben.

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

Verletzungen beim Handball

Vom 13. bis zum 30. Januar 2011 findet die 22. Handball-Weltmeisterschaft der Herren in Schweden statt. Die deutsche Mannschaft befindet sich derzeit im Umbruch, so dass nicht zuletzt auch im Hinblick auf die zurzeit bestehende Verletzungsmisere nicht mit einer Wiederholung des Titelgewinns von 2007 zu rechnen ist. Bei günstigem Turnierverlauf erscheint ein 5. bis 8. Platz realistisch.

Handball ist ein athletischer Sport, der die Elemente Laufen, Springen und Werfen kombiniert. Aufgrund des gleichzeitig entstehenden Gegnerkontakts werden die beabsichtigten Bewegungsabläufe durch erlaubte und unerlaubte Behinderungen oft plötzlich und ruckartig so beeinflusst, dass koordinierte Bewegungsdurchführungen wie Richtungswechsel beim Laufen, Landung nach Sprungwurf und saubere Wurfbewegungen nicht möglich sind.

Das Handballspiel ist in den letzten Jahren insgesamt dynamischer geworden. Neben der zunehmenden Laufgeschwindigkeit (Gegenstoß) nehmen Sprungkraft, Wurfkraft und Wurfgeschwindigkeit zu. Hierbei werden Geschwindigkeiten von bis zu 130 km/h erreicht. Die dafür erforderlichen motorischen Fähigkeiten werden im Training jedoch häufig zu wenig eingeübt. Dies dürfte einer der Gründe für die in den letzten Jahren kontinuierlich angestiegene Verletzungshäufigkeit im Handballsport sein.

Verletzungsträchtige Sportart
In Deutschland zählt der Handballsport statistisch zu den verletzungsträchtigsten Sportarten. Von allen Sportverletzungen im Vereinssport betreffen 15,2 % den Handballsport, getrennt nach Geschlechtern in 13,2 % bei Männern und in 20,8 % bei Frauen. Damit liegt Handball geschlechtsunabhängig hinter Fußball an zweiter Stelle, etwa vergleichbar mit Basketball und Volleyball. Die Verletzungshäufigkeit im Handballsport liegt für männliche wie weibliche Spieler bei 11,2 bis 14,3 pro 1.000 Spielstunden und bei 0,6 bis 2,6 pro 1.000 Trainingsstunden. Dabei betreffen 79 % bis 93 % der Unfälle akute Verletzungen; 7 % bis 21 % sind überlastungsschäden.

Akute Verletzungen
Die höchste Inzidenz haben Distorsionen mit bis zu 65 %. Muskel- und Sehnenverletzungen treten in bis zu 12 %, Prellungen in bis zu 10 % auf. Im Bereich der ersten Handball-Bundesliga wird über eine deutlich höhere Inzidenz von Prellungen (28 %) berichtet. Frakturen und Luxationen treten relativ selten auf (2 bis 7 % bzw. 2 bis 6 %).

Statistische Untersuchungen im Handball weisen eine deutlich höhere Verletzungsrate für die unteren Extremitäten nach. Dabei sind die Sprung- und Kniegelenke am häufigsten betroffen. Kreuzbandverletzungen treten generell in Ballsportarten bei Frauen häufiger auf, für den Handballsport besteht eine dreifach höhere Inzidenz. Insgesamt liegt die Kreuzbandverletzungsrate im Handball für Männer bei 0,21 bis 0,84 pro 1.000 Stunden Wettkampf bzw. 0,03 pro 1.000 Stunden Training, für Frauen bei 0,72 bis 2,79 pro 1.000 Stunden Wettkampf bzw. 0,03 pro 1.000 Stunden Training.

Bei den oberen Extremitäten treten im Handball vor allem Fingerverletzungen auf. Augenverletzungen betreffen häufig den Torwart, der aufgrund der kurzen Wurfdistanz meist keine Schutzreaktionszeit hat.

Überlastungsschäden
Es existieren nur wenige Untersuchungen zu überlastungsschäden im Handball. In der Inzidenz und im Verteilungsmuster bestehen deutliche Differenzen zu den Akutverletzungen. Betroffen sind vor allem das Schultergelenk und die Lendenwirbelsäule. Untersuchungen bei Handballnationalspielern und -spielerinnen dokumentierten in 37 % chronische Kreuzschmerzen und in 32 % langfristig andauernde Schulterbeschwerden. Eine mögliche Erklärung der chronischen Wirbelsäulenbeschwerden im Lendenbereich ist eine gehäuft diagnostizierte muskuläre Verkürzung im Lenden-Becken-Hüftbereich sowie eine muskuläre Imbalance der Bauch- und Rückenmuskulatur. Oft sind die chronischen Schulterbeschwerden auf eine vom Spieler nicht wahrgenommene Schulterinstabilität zurückzuführen. Bei etwa 48.000 Wurfbewegungen pro Jahr mit Geschwindigkeiten von über 100 km/h treten repetitive Mikrotraumata an der vorderen Gelenkkapsel und Bändern durch die Ausholbewegung des Armes bei der Wurfbewegung auf.

Verletzungsprophylaxe
Durch koordinatives Aufwärmtraining beispielsweise auf einer Weichmatte oder einem Wackelbrett lassen sich viele Bandverletzungen an Knie- und Sprunggelenken vermeiden. Bei skandinavischen Damen-Handballmannschaften konnte in wissenschaftlichen Studien nachgewiesen werden, dass durch ein entsprechendes Koordinationstraining das Risiko für Kreuzbandverletzungen auf ein Zehntel gesenkt werden konnte. Nach Abbruch des spezifischen Trainings kehrte die Verletzungshäufigkeit innerhalb eines Jahres auf den Ausgangszustand zurück.

Bezüglich der chronischen Schulterbeschwerden sollte ein gezieltes Muskelaufbautraining für die vernachlässigten hinteren Muskelpartien (Schulterblattmuskeln) durchgeführt werden, um Muskelgleichgewichte wiederherzustellen. Hierbei kommt den behandelnden ärzten und Physiotherapeuten eine wichtige Beratungsfunktion zu, am besten schon im Rahmen von Nachwuchslehrgängen, um Spielern und Trainern die Wichtigkeit eines spezifischen Vorbeuge-Trainings immer wieder vor Augen zu führen.

Lokalisation der Verletzungen beim Handball
(Ritsch 2005, n=600)

Betroffene Struktur Häufigkeit
Kopf 95 (8,8 %)
Stamm 69 (6,4 %)
– davon Wirbelsäule 32 (3,0 %)
obere Extremität 309 (28,5 %)
– Schulter/Oberarm 72 (6,6 %)
– Ellbogen/Unterarm 52 (4,8 %)
– Handgelenk 40 (3,7 %)
– Hand/Finger 145 (13,4 %)
untere Extremität 608 (56,1 %)
– Becken/Hüfte 38 (3,5 %)
– Oberschenkel 192 (8,5 %)
– Kniegelenke 175 (16,1 %)
– Unterschenkel 57 (5,3 %)
– Sprunggelenk 185 (17,1 %)
– Fuß/Zehen 61 (5,6 %)
sonstiges 3 (0,3 %)

Autor: Dr. Hans-Gerd Pieper, Zentrum für Schulterchirurgie, Arthroskopische Chirurgie und Sporttraumatologie, Roland-Klinik am Werdersee in Bremen

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