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Karate aus sportmedizinischer Sicht

Karate aus sportmedizinischer Sicht

Sehr geehrte Damen und Herren,

in Deutschland ist die Anzahl der registrierten Karateka in den letzten Jahren sprunghaft angestiegen. 170.000 registrierte Mitglieder zählt der Deutsche Karate Verband (DKV). Wir widmen uns dem aus Japan stammenden Kampfsport in diesem Newsletter aus sportmedizinischer Sicht. Alle Inhalte sind wie immer zur Veröffentlichung und weiteren Verwendung freigegeben.

In drei Monaten findet in München vom 20. bis 21. Juni 2014 der 29. GOTS-Jahreskongress statt – parallel zur Fußball-Weltmeisterschaft in Brasilien. Das detaillierte Programm finden Sie ab sofort auf der Website des Kongresses (gots-kongress.org).

Die Pressekonferenz, die am 21. Juni 2014 um 13.15 Uhr innerhalb des Kongresses im Hilton Munich Park am Englischen Garten stattfindet, wird sich schwerpunktmäßig mit dem Thema Profifußball beschäftigen. Ein hochkarätiges Podium wird den Journalisten Rede und Antwort stehen. Bitte notieren Sie diesen Termin in Ihrem Redaktionskalender.

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

Karate aus sportmedizinischer Sicht

Karatedo, der Weg der „leeren Hand“, entstand auf den japanischen Ryukyu-Inseln (Hauptinsel Okinawa) im 17. Jahrhundert unter dem Einfluss des damaligen Waffenverbots. Chinesische Kampfkünste (z.B. Shaolin Kung Fu) befruchteten die Karatetechniken durch den kulturellen Austausch im Rahmen der engen Handelsbeziehungen zu China. Seit dem Ende des zweiten Weltkriegs fand Karate zunehmend Einzug in die westliche Welt (USA, Großbritannien) und erfreut sich seit den 70er-Jahren steigender Beliebtheit auch in der Schweiz, Österreich und Deutschland. In Deutschland ist die Anzahl der registrierten Karateka in den letzten Jahren sprunghaft angestiegen auf über 170.000 registrierte Mitglieder im Deutschen Karate Verband (DKV).

Im Gegensatz zu anderen Spotarten existieren beim Karate mehrere unterschiedliche Stilrichtungen mit vielzähligen Schulen (Dojo), welche sich jeweils in eigenen nationalen und internationalen Verbänden zusammengeschlossen haben. Karate ist eine vom IOC anerkannte Sportart, jedoch nicht olympisch. Karate unterteilt sich in die drei Säulen der Grundschule (Kihon), dem virtuellen Kampf ohne Gegner (Kata, Schattenkampf) und dem Freikampf (Kumite). Auf Karateturnieren werden vornehmlich die Disziplinen Kata und Kumite ausgetragen. Bei der Kata werden Dynamik und der richtige Rhythmus gewertet, beim Kumite die korrekte Platzierung der Treffer.

Obligatorische Schutzausrüstung

Als Kleidung getragen wird der Karate-Gi (Kimono) mit rotem oder blauem Gürtel als Unterscheidungsmerkmal der Kämpfer. Der hierarchische Gürtelrang spiegelt den Leistungsstand der Kämpfer wider. Beim Kumite sind nach den Regeln der World Karate Federation (WKF) Zahnschutz, Hand-, Schienbein- und Fußschoner obligatorisch. Seit 2010 ist zusätzlich bei beiden Geschlechtern ein Brustschutz Vorschrift und bei Männern ein Tiefschutz. Eine Face-Mask ist nur bei Kindern und Jugendlichen zwingend vorgesehen. Beim Freikampf wird je nach Stilrichtung Niedrigkontakt Karate praktiziert, bei dem Schläge und Tritte bewusst vor einem möglichen Kontakt mit dem Gegner abgebremst werden, oder Vollkontakt Karate, bei dem ähnlich wie im Teakwondo eine erweiterte Schutzausrüstung getragen wird. Im Kumite wird folgende Punkteregelung angewandt: Fußtritte zum Kopf oder Würfe mit Folgetechnik ergeben 3 Punkte (Sanbon). Tritte zum Rumpf 2 Punkte (Nihon) und alle anderen Techniken ergeben 1 Punkt. Gekämpft wird auf 8 Punkte innerhalb von 2 Minuten.

Komplexer und anspruchsvoller Kampfsport

Im Vergleich zu anderen Kampfsportarten (z.B. Teakwondo) ist Karate eine hochkomplexe Sportart, die dem Athleten neben einem Höchstmaß an technisch-taktischen Fähigkeiten vor allem eine hohe Explosivität (Schnellkraft und Schnellkraftausdauer) abverlangt. Einzelne Kampffolgen und Kampfsequenzen müssen ständig trainiert werden, um im Wettkampf unmittelbar und über Reflexe (Kleinhirn) abrufbar zu sein. Die Einteilung in Gewichtsklassen zwingt Wettkampfteilnehmer zur konsequenten Kontrolle des Körperfettanteils. Das Training der Grundlagenausdauer bildet den Grundstock der raschen Regeneration in Training und Wettkampf. Gemäß einer Studie von Beneke et al. findet der Großteil der 2- bis 4-minütigen Wettkampfbelastung im Kumite (77,8 %) im rein aeroben Bereich statt. Dennoch führen anaerobe Maximalbelastungen in den oft nur Sekunden dauernden eigentlichen Nahkampfphasen zu hohen Laktatkonzentrationen >15 mmol/l im Blut, so dass gemäß den DKV Empfehlungen zusätzlich eine Verbesserung der Laktattoleranz durch ein anaerobes laktazides Training angestrebt werden sollte. Als sportphysiologische Leistungstests kommt neben den herkömmlichen Testbatterien der Ausdauersportarten (Feldtest, Laufbandanalyse mit Bestimmung VO2max) in den letzten Jahren vermehrt der KSAT (Karate Spezifische Ausdauer Test) zur Bestimmung der aeroben Leistungsfähigkeit zur Anwendung. Gute Karateka erreichen VO2max Werte von über 60 ml/kg/min. Karate-sportartspezifische Tests zur Bestimmung der anaeroben Belastbarkeit sind nicht beschrieben. Alternativ werden der 30-s-Wingate-Test und zur Bestimmung der Schnellkraft der Vertical-Jump-Test eingesetzt.

Neben dem Training von Kraft und Ausdauer spielt das Training der Beweglichkeit und Reaktionsschnelligkeit im Karate eine entscheidende Rolle. Ein hoher Bewegungsumfang in Schulter- und Hüftgelenk ist zur Durchführung der Schläge und Tritte essentiell und wird durch intensives Stretching von klein auf geübt. Hierbei wird teilweise auch eine Belastung der Gelenke bis an die Grenzen des physiologischen Bewegungsumfangs in Kauf genommen. Die Variabilität des Trainings und der hohe Anteil propriozeptiver Trainingsreize erklären andererseits aber auch die zahlreichen positiven Auswirkungen des Karatetrainings bis ins höhere Alter.

Akute Kontaktverletzungen

Beim Karate überwiegen im Kumite akute Kontaktverletzungen, im Kata eher Überlastungssverletzungen. Im Niedrigkontakt Karate treten durch den Verzicht auf Trefferwirkungen ernsthaftere Verletzungen selten auf und stellen zumeist ein Versehen dar, welches als Foul durch die Kampfrichter geahndet wird. Dennoch kommt es immer wieder zu Prellungen und Verstauchungen mit oder ohne Fremdeinwirkung. Im Vollkontakt Karate verhindert die Schutzausrüstung zumeist ernsthafte Verletzungen. In der Betreuung von Kinderturnieren sind es zumeist Bagatellverletzungen wie harmlose Schürfungen und Platzwunden, Prellungen und Hämatome, Verstauchungen an Finger- und Zehengelenken, welche zu Konsultationen des Turnierarztes führen. Allerdings gilt es versehentliche Kontakttreffer gegen Bauch und Brustkorb bei Kindern (flexible Rippen, weiche Bauchdecke) nicht zu unterschätzen. Die Autoren selbst mussten Fälle mit nachgewiesenen Milzrupturen behandeln. Eine konzentrierte Beobachtung der Kampfszenen durch den Turnierarzt und eine enge Kommunikation mit den Kampfrichtern hilft die jeweilige Situation richtig einzuschätzen, um überflüssige Krankenhauseinweisungen zu vermeiden.

Mit zunehmendem Ausbildungsniveau der Karateka geht die Bedeutung der Bagatellverletzungen in der Behandlung tendenziell zurück – die Sportler werden oft gar nicht erst vorstellig. Aufgrund der Zunahme der kinetischen Energie der Angriffstechniken kommen ernsthaftere Verletzungen wie AC-Gelenksdistorsionen, Klavikulafrakturen, Finger- und Zehenfrakturen und -luxationen oder Bandläsionen an Knie und Sprunggelenk häufiger vor. Selten sind Schulterluxationen und Patellaluxationen zu verzeichnen. Luxationen am Knie sowie Frakturen der langen Röhrenknochen, der großen Gelenke oder der Wirbelsäule stellen eine absolute Ausnahme dar. Muskelfaser- und Sehnenverletzungen (Hamstrings, Achillessehne) sowie Meniskusläsionen im Rahmen von Kniedistorsionen sind gelegentlich auszumachen, teilweise bei überlastungsbedingter degenerativer Vorschädigung. Schädelprellungen sind häufig, echte Gehirnerschütterungen (sports concussion) eher selten, im Falle des Auftretens aber konsequent zu behandeln.

Ursachen akuter Verletzungen

Eine Rückkehr in Training und Wettkampf analog der Return-to-Play-Protokolle anderer Sportarten (SIHA, Swiss Icehockey Association) hat sich bewährt. Eine Studie während der WKF Weltmeisterschaften in der Türkei 2010 gibt als häufigste Ursachen akuter Verletzungen ungenügendes Warm-up (22,4 %), Verletzung durch Trainingspartner (19,4 %), ungenügenden physischen Trainingszustand und ungenügende Schutzausrüstung (jeweils 8,9 %) an. Mehrheitlich ereignen sich die Verletzungen im Training. Die u.a. Tabelle gibt die häufigsten Verletzungen kumuliert in Karate, Jiu-Jitsu und Judo wieder, wobei gemäß der Erfahrungen der Autoren Frakturen und Luxationen im Karate seltener vorkommen, möglicherweise bedingt durch den geringeren Stellenwert der Wurf- und Hebeltechniken.

Chronische Verletzungen und karatetypische Überlastungsverletzungen

Aufgabe des betreuenden Arztes

Bei Überlastungsverletzungen kann der Arzt während der Vorbereitungsphasen nach Rücksprache mit den Trainern geeignete Trainingsumstellungen zur Sekundärprophylaxe bewirken. Während der Vorbereitungsphasen sollte das Vollkontakttraining nicht oder nur sehr gut geschützt stattfinden, um Verletzungen vor Turnieren möglichst zu vermeiden. Bei steigendem Leistungsniveau sollten Leistungstests und Ernährungsberatung angeboten werden. In den Wettkämpfen wird der betreuende Arzt vielfach beansprucht: Ernährungsberatung (ausreichende Trinkmenge, Ernährungstipps), allgemeinmedizinische Fragen (grippale Infekte, gastrointestinale Probleme). Bei akuten Verletzungen muss auf der Kampffläche schnell entschieden werden, ob der Kampf abgebrochen werden muss. Zumeist steht die Behandlung von Bagatellverletzungen im Vordergrund. Dennoch treten in den Turnieren auch immer wieder ernsthaftere Verletzungen auf, die vor Ort adäquat erstversorgt werden müssen mit nachfolgender Krankenhauseinweisung. Die Rückkehr zum Karate sollte erst nach kompletter propriozeptiver Rehabilitation erfolgen.

Aspekte der sportartspezifischen Verletzungsprophylaxe

Die üblichen Empfehlungen zur Verletzungsprophylaxe erscheinen im Karate wenig zielführend, stellt doch das Training propriozeptiver und koordinativer Fähigkeiten den Grundstock der sportlichen Ausbildung dar. Das Tragen gelenkstabilisierender Bandagen kann im Einzelfall hilfreich sein. Muskuläre Verkürzungen, Dysbalancen und Verkettungssyndrome treten durch gezielte Dehnübungen als integraler Bestandteil der Sportart und die Variabilität des Trainings im Vergleich zu anderen Sportarten nicht gehäuft auf. Durch den zunehmenden Verzicht auf sogenannte Bruchtests (Tameshivari: Zerschlagen von Brettern, Ziegeln etc.) treten bestimmte typische Verletzungen (z.B. Läsionen der Metacarpophalangealgelenke, Verkalkungen an der Schienbeinvorderkante) nur noch selten auf. Das streng hierarchisch geordnete Gürtelsystem erlaubt den Trainern eine individuelle Förderung der einzelnen Schüler ohne Überforderung. Im Wettkampf entscheidend ist zur Verletzungsprophylaxe eine hohe Qualität der Kampfrichter, um bei Ungleichheit der Kontrahenten schützend einschreiten zu können. Die vorgeschriebene Schutzausrüstung erscheint weitgehend optimiert.

Zusammenfassung und Ausblick

Karate ist zweifellos eine der boomenden Sportarten unserer Zeit. In einigen Dojos werden bereits schon Kurse für Kleinkinder angeboten und zahlreich nachgefragt, aufgrund der faszinierenden Kombination aus Koordinations-, Schnellkraft- und Konzentrationstraining gepaart mit der Vermittlung der kulturellen Grundwerte im Karate: Höflichkeit, Disziplin, Aufmerksamkeit und gegenseitiger Respekt. Bei kontinuierlichem Training kann Karate (Kihon und Kata) bis ins hohe Alter betrieben werden. Die Häufigkeit relevanter Verletzungen ist durch die konsequente Regelumsetzung zumindest im Niedrigkontaktkarate eher gering. Defizite bestehen bezüglich aussagekräftiger Studien zur sportartspezifischen chronischen Verletzungsmustern und Überlastungssyndromen sowie in der sportartspezifischen Trainingssteuerung der aeroben und anaeroben Leistungsfähigkeit, der Ernährungssteuerung und der Verletzungsprophylaxe.

Verletzungshäufigkeit kumuliert im Karate, Jiu-Jitsu und Judo

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

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 4,7 %

Über die Autoren:
Dr. med. Olaf Büttner, Stv. Ärztlicher Leiter MVZ Klinikum Ingolstadt, Facharzt für Orthopädie und Unfallchirurgie, Sportmedizin, Manuelle Medizin/Chirotherapie, Mannschaftsarzt des ERC Ingolstadt (Eishockey, DEL) und des FC Ingolstadt 04 (2. Fußball-Bundesliga), Stv. Verbandsarzt Swiss Shotokan Karate-Do Federation
Dr. med. Claudio Rosso, Oberarzt, Stv. Teamleiter Schulter- und Ellenbogenchirurgie, Universitätsspital Basel, Schweiz; Verbandsarzt Swiss Shotokan Karate-Do Federation; Stv. Verbandsarzt Swiss Karate Federation (SKF); Gründer und Co-Cheftrainer Swiss Shotokan Karate-Do Basel; Vize-Welt und Europameister WSKF 2007/2008, mehrfacher Schweizer Meister Kumite und Kata einzel und Team

Korrespondenz: Claudio.Rosso@unibas.ch; Termine Kampfsportsprechstunde: +41 61 265 3626

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