GOTS – Pressenewsletter 08.09.2011
Sehr geehrte Damen und Herren,
in diesen Tagen findet die Kanuslalom-Weltmeisterschaft in Bratislava in der Slowakei statt, die zugleich auch Qualifikationswettbewerb für die Olympischen Sommerspiele im nächsten Jahr ist. Wie verletzungsanfällig ist der raue und nasse Sport? Die Antworten finden Sie in diesem Newsletter
Mit freundlichen Grüßen,
Frank Wechsel und Dr. Wolfgang Schillings, GOTS-Pressesprecher
Pressetext: Verletzungen beim Kanusport
In diesen Tagen findet die Kanuslalom-Weltmeisterschaft in Bratislava in der Slowakei statt, die zugleich auch Qualifikationswettbewerb für die Olympischen Sommerspiele im nächsten Jahr ist. In allen vier olympischen Disziplinen, dem Kajak Einer der Damen und der Herren sowie bei den Einer- und Zweier-Canadiern hat der Deutsche Kanu-Verband heiße Medaillenanwärter am Start.
Kanuslalom hat sich in den letzten Jahren zu einer immer dynamischeren Sportart entwickelt. Die Strecken wurden von über 200 Sekunden auf etwa 100 Sekunden verkürzt. Das Gefälle auf den Strecken hat sich bei den neu erbauten Kunstkanälen mehr als verdoppelt. Die Boote sind kürzer und drehfreudiger. Und nach Qualifikationsläufen entscheidet nur noch ein Lauf über den Sieg. Dadurch haben sich die konditionellen Anforderungen mehr in den Kraft und Schnellkraftbereich verlagert. Die orthopädischen Probleme sind zusätzlich zum Schulter- nun häufiger auch im Rumpfbereich durch extreme Verwindungen und explosive Rotationsbewegungen bei Richtungswechseln anzutreffen. Ansatzbeschwerden der Bauchmuskulatur am unteren Rippenbogen treten mittlerweile genauso häufig wie Probleme an der Rotatorenmanschette der Schulter auf.
Umfangreiches Techniktraining
Kajakfahrer treiben ihr Boot in sitzender Position mit einem Doppelpaddel voran, während Canadiersportler in kniender Position lediglich ein Stechpaddel benutzen. Im internationalen Spitzenbereich ist ein Wochentrainingsaufwand von 800 bis 1.400 Trainingsminuten üblich. Die enormen Variationsmöglichkeiten der inzwischen vorwiegend künstlichen Strecken mit modularen Hindernissen setzen ein umfangreiches Techniktraining voraus. Der Kraftaufwand ist gerade bei Technikeinheiten sehr hoch, Spitzenathleten im Herren Kajak entfalten etwa 400 bis 450 N, im Canadier bis zu 600 N Druck auf dem Paddel. Hier dienen komplexe leistungsdiagnostische Auswertungen als wesentliches Präventionsinstrument zur Erkennung möglicher Überlastungsschäden.
Zentrale Rolle der Schulter
Die akuten Verletzungsmuster teilen sich jeweils zu einem Viertel in Schürfwunden, Tendinitiden und Kontusionen beziehungsweise Distorsionen auf, Dislokationen machen fünf Prozent aus. Chronische Beschwerden werden am häufigsten durch eine Tendinitis oder eine Tendovaginitis (45 Prozent), gefolgt von Kontusionen und Distorsionen (25 Prozent) verursacht.
Die Schulter spielt in der Kraftübertragungskette zwischen Paddel und Boot eine zentrale Rolle, daher finden sich im Bereich der Rotatorenmanschette auch die häufigsten Überlastungsbeschwerden. Häufigste Läsionen sind mit jeweils 20 Prozent die Tendinitis der Bizepssehne sowie Rotatorenmanschetteneinrisse, gefolgt von etwa 14 Prozent Bursitiden. Beim Canadiersport kommt die einseitige Elevation über die 90-Grad-Ebene und Innenrotation mit dem Problem des Impingements auf der Seite des Paddelknaufs in der Druckphase hinzu. Die anteriore Schulterluxation ist die gravierendste Verletzung. Der Versuch, eine Kenterung durch eine Stützbewegung mit eleviertem Arm (Außenrotation und Abduktion im Schultergelenk) zu vermeiden, ist beim Kajakfahrer durch seine niedrigere Sitzposition typisch, wohingegen Canadierfahrer meist flach mit innenrotiertem adduziertem Arm stützen. Daher sind Kajakfahrer deutlich häufiger von Schulterluxationen betroffen als Canadierfahrer (aktuelle Nationalkader zehn vs. drei Prozent). Der Schwerpunkt in der Prophylaxe liegt daher auf der Technikschulung zur Stabilisation des Bootes aus dem Hüftbereich sowie auf Kräftigungsübungen für den Rumpf. Schulterstabilisationsübungen nach krankengymnastischer Anleitung (zum Beispiel mit dem Thera-Band® und dem Flexi-Bar®) sollten in die Aufwärmarbeit eingebaut werden.
Rückenbeschwerden bei Canadierfahrern häufiger
Die Häufigkeit von Wirbelsäulenbeschwerden wird mit etwa 15 Prozent angegeben. Durch die Seitneigung werden bei Canadierfahrern häufiger als beim Kajaksportler Funktionsstörungen beklagt. Die Beschwerden treten – bedingt durch die Sitzposition – im Canadiersport häufiger in den cranialen, im Kajak gehäuft in den kaudalen Wirbelsäulenabschnitten auf. Eine adäquat vorbereitete Rumpfmuskulatur mit stabiler Technik ist auch für die Wirbelsäule der wichtigste präventive Faktor.
Neben der Therapie der Verletzungen und Überlastungen, liegen die Behandlungsschwerpunkte vor allem auf der Therapie von Infekten des Respirationstraktes.
Lokalisation von Verletzungen bei Wildwassersportlern (Angaben in Prozent)
Lokalisation (Wildwasser-Kajak / Wildwasser-Canadier)
akute Verletzungen: 65 / 85
Hand/Handgelenk: 20 / 20
Unterarm/Ellenbogen: 10 / 5
Gesicht: 10 / 25
Schulter: 35 / 10
Fuß: 10 / 10
Knie: 5 / 15
Sonstige: 10 / 15
chronische Verletzungen: 35 / 15
Hand/Handgelenk: 35 / 5
Unterarm/Ellenbogen: 20 / 30
Schulter: 30 / 35
Rücken: 15 / 30
Der Autor:
Dr. med. Roland Eisele, Chefarzt Innere Medizin am Kreiskrankenhaus Blaubeuren, Schwerpunkt Gastroenterologie, Zusatzbezeichnung Sportmedizin, Manuelle Therapie, Ernährungsmedizin; bis 1991 Athlet der Nationalmannschaft Kanu Slalom, 1992-1997 Sportmedizinisches Institut der Bw in Warendorf, 1994-2000 verantwortlicher Arzt des Deutschen Schwimm Verbandes, Bereich Leistungssport, seit 2001 verantwortlicher Arzt des Deutschen Kanu Verbandes, Bereich Kanu-Slalom, Stützpunktarzt des Olympiastützpunktes Bayern, GOTS-Mitglied.
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