GOTS – Newsletter vom 27.05.2010
Sehr geehrte Damen und Herren,
die Trendsportart Klettern wird von der Allgemeinheit immer noch als risikoreich bewertet. Doch die tatsächlichen Verletzungszahlen sprechen eine andere Sprache. Trotzdem ist nach dem eisigen Winter besondere Vorsicht geboten. Mehr dazu finden Sie in diesem Newsletter.
Mit freundlichen Grüßen,
Frank Wechsel und Dr. Wolfgang Schillings, GOTS-Pressesprecher
GOTS-Pressekonferenz am 17. Juni 2010 um 11 Uhr in München
Der 25. Jahreskongress der Gesellschaft für Orthopädisch-Traumatologische Sportmedizin (GOTS) findet vom 18. bis 20. Juni 2010 im Klinikum Großhadern in München statt. Bereits am 17. Juni 2010 informiert Sie die GOTS auf einer Pressekonferenz um 11 Uhr im Hotel Arabella Sheraton am Westpark über das abwechslungsreiche Kongressprogramm und aktuelle Themen aus der Sportmedizin. Schwerpunktthema ist – passend zur im gleichen Zeitraum stattfindenden WM – Fußball. Wie in jedem Jahr wird der Praxisbezug durch das Gespräch mit hochrangigen Spitzensportlern hergestellt.
Weitere Informationen zur Pressekonferenz erhalten Sie in den kommenden Tagen. Das Programm des 25. Jahreskongresses der GOTS finden Sie unter www.gots-kongress.org.
Verletzungen beim Sportklettern
Nach dem langen und schneereichen Winter hat sie endlich wieder begonnen: die Klettersaison im Fels. Auch die Wettkampfsaison 2010 ist in vollem Gange und wird im Juli mit dem Boulder-Weltcup in München für so manchen deutschen Starter ihren Saisonhöhepunkt finden. Nach dem deutschen Weltcupsieg von Jonas Baumann in Vail 2009 wird sich dieser in München sicher in Topform präsentieren. Leider kamen mit den Feiertagen aber auch die ersten Kletterunfälle. Gerade durch den schweren Frost dieses Winters ist die Gefahr eines Felsausbruchs im Frühjahr groß. Dies gilt vor allem für die löchrigen Kalksteinfelsen der Fränkischen Schweiz.
Das extreme Klettern fand Anfang der 70er-Jahre eine radikale Wende. War bis dahin nur das Ziel und nicht der Weg zum Ziel die Herausforderung, so wurde nun die Idee des “freien Kletterns” geboren. Freiklettern bezieht sich auf die freie Durchsteigung einer Klettertour, das heißt das Seil und die Sicherungsmittel dienen nur der Absicherung des Kletterers und nicht als Fortbewegungsmittel. Während in der Öffentlichkeit noch die Meinung vom Risikosport verbreitet ist, stellte sich Sportklettern als risikoarm dar. Schwere Unfälle sind dank moderner Sicherungstechniken und Ausrüstung selten. Nach aktuellen Angaben des Deutschen Alpenvereins gibt es derzeit über 300.000 aktive Kletterer in Deutschland, Tendenz steil bergauf. Seit 1991 finden regelmäßig Welt- und Europameisterschaften sowie Weltcups und nationale Wettkämpfe statt. Derzeit sind 76 Nationen im Weltwettkletterverband (IFSC) Mitglied und die Anerkennung durch das IOC erfolgte im Februar 2010. Dachverband des deutschen Klettersportes ist der Deutsche Alpenverein (www.alpenverein.de).
Anforderungs- und Belastungsprofil
Sportklettern zeichnet sich durch relativ kurze, aber hochintensive Belastungen aus. Hierbei ist vor allem die Fingerkraft sowie lokale anaerobe Kraftausdauer der Unterarme leistungsbestimmend. Klettern beinhaltet eine natürliche Bewegung, die quasi von klein auf spielerisch erlernt wird. Da der Klettersport wesentlich vom Verhältnis Kraft zu Körpergewicht bestimmt ist, sind Essstörungen nicht selten. Zur Kletterausrüstung gehören spezielle Kletterschuhe, Klettergurt, Seil und Karabiner. Ein gemeinsames Merkmal aller Kletterschuhe ist die Tatsache, dass sie möglichst eng getragen werden, um einen optimalen Felskontakt zu vermitteln. Dies führt häufig zu gesundheitlichen Problemen. Die Einführung von Bohrhaken war wichtiger Wegbereiter für die explosionsartige Leistungssteigerung im Klettersport. So gehören mittlerweile Stürze ins Seil zur Tagesordnung des Sportkletterers.
Akute Verletzungen
Bei Verletzungen und Überlastungen von Sportkletterern stehen Finger- und Handläsionen im Vordergrund (siehe Tabelle). Die häufigste akute Verletzung bei den vom Autor untersuchten Patienten stellt dabei die Ringbandruptur dar, gefolgt von Kapsel-Bandverletzungen der Fingergelenke und Sehnenverletzungen. Während die Diagnose und Therapie der meisten dieser Verletzungen für den Sportmediziner keine Schwierigkeit darstellen, sind die Ringbandverletzungen jedoch eine eigene Entität, die in anderen Sportarten äußerst selten vorkommt. Sturzverletzungen führen, weitaus seltener, vor allem zu Verletzungen der unteren Extremität, einerseits durch Bodenaufprall, andererseits durch Felskontakt beim Sturz. Es finden sich häufig Sprunggelenks- und Fersenbeinbrüche. Schwere Verletzungen und Polytraumata sind vergleichsweise selten.
Chronische Verletzungen
Bei chronischen Verletzungen finden sich vor allem Tenosynovitiden der Fingerbeugesehnen, Epikondylitiden sowie andere Sehnenansatzentzündungen. Aber auch Schulterprobleme mit Instabilitäten, SLAP-Läsionen und Bizepssehnentendinosen treten zunehmend in den Vordergrund. Chronische Überlastungsreaktionen korrelieren mit Schwierigkeitsniveau und Kletterintensität. Speziell zu beachten sind Ermüdungsfrakturen im Bereich der Wachstumsfugen jugendlicher Kletterer. Berichten 12- bis 15-Jährige über belastungsinduzierte Fingerschmerzen, muss eine Verletzung der Wachstumsfuge mittels Schichtbildaufnahme ausgeschlossen werden, falls sich keine andere Diagnose findet und das Röntgenbild unauffällig ist. Weitere chronische Problematiken sind Arthrosen der Fingergelenke und Handwurzeln.
Spezielle Rolle des betreuenden Arztes
In der Klettererbetreuung spielt vor allem bei Jugendlichen die Vorbeugung eine essenzielle Rolle. Hierbei gilt es, die Kinder und Jugendlichen jährlich aus orthopädischen und pädiatrischen Gesichtspunkten zu beurteilen. So können reversible Bewegungseinschränkungen der Finger früh erkannt und vor allem Epiphysenverletzungen detektiert werden. Aber auch der Gesamtentwicklungszustand des Kindes muss berücksichtigt werden. Nur so lassen sich zum Beispiel Essstörungen frühzeitig erkennen. Häufig sind weiterhin Muskelverkürzungen der Unterarmbeuger und eine Fehlhaltung der Brustwirbelsäule mit Kyphose (Klettererrücken). Hochintensives Fingerkrafttraining, zum Beispiel am Campusboard, darf in jungen Jahren nicht durchgeführt werden. Während viele Kinderklettergruppen unter regelmäßiger sportmedizinischer Betreuung stehen, ist dies bei Erwachsenen deutlich seltener. Dies muss verbessert werden, denn viele Kletterer suchen erst Monate nach einer Verletzung den Arzt auf.
Tabelle 1: Empfehlungen zur Vorbeugung
- altergemäßes Training
- kein Campusboard-Training im Kinder- und Jugendalter
- Auf- und Abwärmen, vor allem der Fingergelenke
- Ausgleichstraining zur Verbesserung vernachlässigter Muskelgruppen
- Behandeln von Verletzungen statt Negieren
- Therapeutisches Taping nach Ringbandverletzung
- Vermeidung monotoner Trainingsbelastungen
- Partnercheck beim Einbinden und Sichern
Tabelle 2: Die zehn häufigsten Lokalisationen der kletterspezifischen Diagnosen
(1/98–12/01, n=604)
Finger 247 (41,0%)
Unterarm/Ellbogen 81 (13,4%)
Fuß 55 (9,1%)
Hand 47 (7,8%)
Wirbelsäule/Rumpf 43 (7,1%)
Haut 42 (6,9%)
Schulter 30 (5,0%)
Knie 22 (3,6%)
Sonstige 37 (6,1%)
Polytrauma 5 (0,8%)
Tabelle 3: Die zehn häufigsten Verletzungen und Überlastungserscheinungen der Finger (aus dem Gesamtklientel n=604)
Ringbandruptur 74
Ringbandzerrung 48
Tenosynovitis 42
Kapselverletzung 37
Arthritis (akut) 13
Ganglion 11
Sehnenzerrung 7
Fraktur 7
Arthritis (chron.) 5
M. Dupuytren 5
Autor: Priv.-Doz. Dr.Volker Schöffl, MHBA, Leiter der Sektionen Sportorthopädie-Sporttraumatologie-Sportmedizin und Chirurgie der oberen Extremität, Klinikum Bamberg, Leiter Sportmedizinischer Stützpunkt Deutscher Alpenverein und Mannschaftsarzt Kletternationalmannschaft, Mitglied Medizinische Kommission IFSC und UIAA, GOTS-Mitglied
In eigener Sache: Sind Ihre Kontaktdaten aktuell?
Liebe GOTS-Mitglieder,
sind wir auf dem aktuellen Stand? Bitte prüfen Sie Ihre persönlichen Daten, die in der GOTS-Datei auf der Website www.gots.org hinterlegt sind. Mit Ihrer E-Mail-Adresse haben Sie den Zugang.
Herzlichen Dank,
Ihre GOTS-Geschäftsstelle
Petra Enderlein
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