Gesellschaft für Orthopädisch-Traumatologische Sportmedizin

GOTS: Verletzungen im Kampfsport

GOTS – Newsletter vom 05.10.2009

Sehr geehrte Damen und Herren,

in wenigen Tagen beginnt in Kopenhagen die TaeKwonDo-Weltmeisterschaft. Wie gefährlich ist diese Kampfsportart, die auch in Deutschland zunehmende Popularität erfährt? Weitere Informationen dazu finden Sie in diesem Newsletter.

Alle Beiträge dieses Newsletters sind zur weiteren Veröffentlichung freigegeben.

Mit freundlichem Gruß,
Frank Wechsel, GOTS-Pressesprecher

Verletzungen im Kampfsport

Vom 14. bis zum 18. Oktober 2009 wird in Kopenhagen die TeaKwonDo-Weltmeisterschaft ausgetragen. Sie findet alternierend mit den Olympischen Spielen alle zwei Jahre statt. Dem deutschen Team werden, obwohl auf europäischer Ebene sehr erfolgreich, nur geringe Chancen auf einen Titel eingeräumt. Ebenso stehen die Chancen für das schweizerische und österreichische Team. Die dominierende Nation ist Korea – das Ursprungsland des TaeKwonDo.

Taekwondo (Tae = Fuß/Bein, Kwon = Hand, Do = Weg) wird gemeinsam mit Judo, Jiu-Jitsu und Karate zu den traditionellen Kampfsportarten gezählt. Gemeinsam ist diesen Kampfsportarten (martial arts), dass Gibon Yeonseup (Grundschule), Poomse (Formen) und Gyeorugi (Freikampf) gelehrt werden. Seit etwa 4.000 Jahren entwickelte sich TaeKwonDo zu einer der weltweit führenden Kampfsportarten.

Verletzungsmuster können entsprechend in Überlastungsschäden wie bei Poomse oder Gibon Yeonseup und Kontaktverletzungen wie beim Gyeorugi mit gewissen Überschneidungen eingeteilt werden.

Überlastungsschäden bei Gibon Yeonseup und Poomse
In der Literatur finden sich hierzu wenige Angaben. Die Inzidenz wird mit 1,4-3,5 % angegeben. Dies entspricht jedoch nicht den Erfahrungen der Autoren, da hier die Dunkelziffer aufgrund der mangelnden ärztlichen Konsultation sehr hoch ist. Wie von Shan et al. beschrieben, führt das intensive Training in der Poomse zu Überbelastungserscheinungen ähnlich den Schäden bei (Ballett-)Tänzern. Die kleinen Muskeln unterliegen hohen propriozeptiven Belastungen, vor allem im Fußbereich. Hüftbeschwerden im Sinne von Impingement durch hohe Tritte werden ebenfalls beschrieben.

Verletzungen beim Gyeorugi
Der Olympische Kampf dauert drei Runden à je zwei Minuten mit jeweils einer Minute Pause. Er wird mit Kopfschutz, Schienbein- und Ellbogenschonern, Tiefschutz, Zahnschutz und Brustpanzer nach Vollkontakt-Regeln ausgeführt. Im traditionellen TaeKwonDo steht der Freikampf weniger im Fokus, hier wird nach Leicht- und Halbkontakt-Regeln gekämpft. Es gibt eine generelle Tendenz in den traditionellen Kampfsportarten, bei der eine Vereinheitlichung der Stile erreicht werden soll. Gefördert werden hier meist die Wettkampfsportler, welche die Kampfkunst oft nur in einem Teilbereich (Kampf oder Form) beherrschen.

In der unten aufgeführten Tabelle sind die Verletzungsmuster der drei traditionellen Kampfsportarten Karate, Judo und Jiu-Jitsu nach Regionen aufgezeigt. Hierbei ist hervorzuheben, dass die unteren Extremitäten führend in der Statistik sind, dominierend sind dabei Distorsionen mit 20,6%.

Tab.: Häufige Verletzungen beim Karate, Judo und Jiu-Jitsu kumuliert

Region [%]
Kopf/Hals 10.0
geschlossene Nasenbeinfraktur 0.9
geschlossene Orbitafraktur 0.2
Commotio cerebri 0.6
Zahnfraktur/-luxation 1.9
Kopf-/Halskontusionen exkl. Auge 2.8
Bulbuskontusion 0.2
Rest 4.0
Rumpf/Thorax/Wirbelsäule 15.0
geschlossene Rippenfraktur 2.8
Thorax- und Rückenkontusion 7.4
Bauch -und Lendenkontusion 1.7
Rest 3.0
Obere Extremitäten 28.0
Clavicula-/Skapula-/Humerusfraktur 2.3
Schulter-/AC-/SC-Luxationen 4.3
Frakturen an der Hand 2.6
Kontusionen Schulter/Ober-/Unterarm 8.7
Kontusionen Hand 8.3
offene Wunden 1.1
Rest < 1
Untere Extremitäten 41.8
Frakturen der Tibia, Fibula 0.2
Frakturen des Fußes 4.0
Meniskusläsionen 3.6
Patellaluxationen 0.2
sonstige Bandläsionen am Knie 5.3
OSG-Distorsion 5.1
Fußluxationen 0.4
Kontusionen 6.4
Distorsionen außer OSG 15.5
Lazerationen 0.6
Rest 0.4
Restliche Verletzungen 7

 

Quelle: Sammelstelle für die Statistik der Unfallversicherung UVG (SSUV)

Nach Häufigkeiten der betroffenen Regionen im Karate, Judo und Jiu-Jitsu zusammen ergibt sich folgende Verletzungsverteilung:

– Beine und Hüfte = 41,8%
– Arme und Schulter = 28,0%
– Brust, Bauch, Rücken = 15,0%
– Kopf, Hals = 10,0%
– andere Verletzungen = 4,7%

Nach Angaben von Zetaruk sind beim Taekwondo im Vergleich zu anderen Kampfsportarten (Karate, Aikido, Kung Fu, Tai Chi) das Verletzungsrisiko und das Risiko für schwere Verletzungen mindestens dreifach erhöht. Im Vergleich zum Karate sind Verletzungen beim Taekwondo in folgenden Bereichen signifikant erhöht: Kopf, Hals, Hüfte, Arme, Schulter, Hüfte und Beine.

Nach Angaben der SSUV Schweiz (Sammelstelle für die Statistik der Unfallversicherung UVG) sind beim Taekwondo mit 77,7% Verletzungen der unteren Extremitäten am zahlreichsten. Die vorherrschenden Verletzungen sind laut dieser Statistik Seitenbandverletzungen, Läsionen des vorderen Kreuzbandes, des oberen Sprunggelenks sowie Fußdistorsionen.

Prädiktoren von Verletzungen
Das individuelle Risiko von Verletzungen ist vielgestaltiger Natur. Im Karate konnte gezeigt werden, dass ab einem Alter von 18 Jahren, einer Kampferfahrung von mehr als drei Jahren und einem Trainingspensum von mehr als drei Stunden pro Woche das Verletzungsrisiko signifikant erhöht zu sein scheint. Lystad konnte in einem Review 2008 zeigen, dass im Taekwondo weder das Alter noch das Geschlecht oder der Grad der Athleten in Bezug auf eingetretene Verletzungen eine Rolle spielte.

Vorbeugung
Zur Prävention von Überlastungsschäden wird kontrolliertes propriozeptives Training auf weichem Untergrund empfohlen. Zusätzlich bringt meist eine Veränderung der Trainingsart im Sinne von zusätzlichem, sport-spezifischem Krafttraining eine Besserung der Situation. Eine entscheidende Rolle bei der Vorbeugung von Verletzungen ist die gute Führung durch den Trainer. Bei Kampfsportarten ist das konsequente Durchgreifen der Schiedsrichter mittels Verwarnungen und eventuell auch Kampf- oder Turnierausschluss ein ausschlaggebender Faktor zur Verhinderung von schweren Verletzungen.

Rolle des betreuenden Arztes
Bei Überlastungsschäden kann der Arzt während der Vorbereitungsphasen nach Rücksprache mit den Trainern gewisse Trainingsumstellungen bewirken. Außerdem sollte während der Vorbereitungsphasen das Vollkontakttraining nicht oder nur sehr gut geschützt stattfinden, hier gilt es, Verletzungen, die den Wettkampf behindern, zu vermeiden. Bei steigendem Niveau sollten Leistungstests und Ernährungsberatung erfolgen.

Beim Wettkampf selbst muss der Arzt mehrfach einsatzfähig sein; er berät die Sportler bezüglich Hydratation (belastende Magenfüllung versus Dehydratation mit Leistungsminderung), Ernährung sowie in allen allgemeinmedizinischen Fragen. Bei Traumata muss auf der Kampffläche schnell entschieden werden, ob dem Sportler eine Weiterführung des Kampfes zugemutet werden kann. Zudem steht die Behandlung von Verstauchungen und Hämatomen im Vordergrund. Wichtig sind dabei die Gesundheit des Sportlers und die Rücksprache mit dem Ringrichter, dem Trainer sowie bei Minderjährigen auch mit den Eltern.

Autoren:
Dr. Claudio Rosso, Verbandsarzt der Swiss Shotokan Karate-Do Federation, derzeit Post-Doc-Fellowship in Sportorthopädie an der Harvard Medical School in Boston
Dr. Olaf Büttner, Stellvertretender Verbandsarzt der Swiss Shotokan Karate-Do Federation, Assistenzarzt in der Crossklinik Basel
PD Dr. Dr. Victor Valderrabano, Leiter der Fußorthopädie, designierter Ordinarius für Orthopädie an der Orthopädischen Universitätsklinik Basel

Die GOTS-Geschäftsstelle

Bitte notieren Sie die neuen Kontaktdaten der GOTS:
GOTS-Geschäftsstelle
Petra Enderlein
Heinrich-von-Eggeling-Str.11
07749 Jena

Tel. 0 36 41 / 38 44 78
Fax 0 36 41 / 56 14 47
mobil 0 176 / 240 825 53
E-Mail: info@gots.org

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