Gesellschaft für Orthopädisch-Traumatologische Sportmedizin

Kontaktsport Handball: Sind Frauen häufiger verletzt als Männer?

Sehr geehrte Damen und Herren,

Handball boomt – und hat sich hinter „König“ Fußball als zweitpopulärste Sportart etabliert. Während die besten Wintersportler von Weltcup zu Weltcup reisen, kämpfen die besten Handballerinnen der Welt im Dezember in Dänemark in einem Feld von 24 Mannschaften um den WM-Titel. Was sind die Unterschiede zwischen Frauen- und Männer-Handball, und was sind die größten Gefahren für Verletzungen? Sind Handballerinnen womöglich verletzungsanfälliger als Handballer? Im GOTS-Newsletter gibt Österreichs Top-Handballerin Sonja Frey Antworten aus Sicht der Physiotherapeutin und Bundesligaspielerin des Thüringer HC.


31. Jahreskongress der GOTS | 17. - 18. Juni 2016, Leonardo Royal Hotel, MünchenIn den kommenden Monaten werden wir Sie an dieser Stelle regelmäßig über den 31. Jahreskongress der Gesellschaft für Orthopädisch-Traumatologische Sportmedizin (GOTS)  informieren, der vom 17. bis 18. Juni 2016 in München stattfindet. Aktuell können Sie einen aktiven Beitrag zum wissenschaftlichen Programm leisten – und von sofort an bis zum 01. Dezember 2015 ein Abstract über die Kongresswebsite gots-kongress.org einreichen.


Außerdem möchten wir Sie auf die Jahrestagung der Verbandsärzte Deutschland e.V. vom 04. bis 06. März 2016 in Garmisch-Partenkirchen hinweisen. Nähere Information auch zum Programm entnehmen Sie bitte dem Flyer im Anhang. Anmeldungen sind bis zum 24.12.2015 unter verbandsaerzte.org/events/id/29/  möglich.

Flyer: Jahrestagung der Verbandsärzte Deutschland e.V.

Mit freundlichen Grüßen
Andreas Bellinger, presse@gots.org

 

Kontaktsport Handball: Sind Frauen häufiger verletzt als Männer?

Wenn Weltmeisterschaften anstehen, darf der größte nationale Handball-Verband der Welt natürlich nicht fehlen. Nach den Männern Anfang des Jahres in Katar starten nun auch die Frauen des Deutschen Handball-Bundes (DHB) im Dezember in Dänemark mit einer Wildcard in die Titelkämpfe. Eine Überraschung, wie sie den Männern 2007 mit dem Titel bei der Heim-Weltmeisterschaft gelang, dürfte allerdings eine Utopie bleiben. Überhaupt fristen die Frauen im Handball eher ein Schattendasein. Während in den Arenen der Männer-Bundesliga bis zu 20.000 Anhänger für Stimmung sorgen, verfolgen die Spiele der Frauen regelmäßig nur zwischen 800 und maximal 2.500 Zuschauer. Auch das Fernsehen berichtet live zumeist nur von den Spielen der Männer.

Was macht Handball so attraktiv?
Doch die Aufmerksamkeit steigt – nicht nur in Deutschland. Komplexität und Vielfalt, Dynamik und Schnelligkeit sowie Kampf und Spielwitz, gepaart mit einem gesunden Maß an Aggressivität und Härte, sind die Mixtur, die das Geheimnis der wachsenden Popularität dieses Sports ausmacht. Akrobatische Wurfeinlagen tun ein Übriges. Norwegen und Dänemark gelten seit Jahrzehnten als Talentschmieden und sportliche Großmächte, besonders im Frauen-Handball. Auch in Übersee steigt die Begeisterung, zumal Brasilien bei der WM 2013 in Serbien den Titel holte.

Häufige Verletzungen im Handball
Handball hat sich mehr und mehr zu einem Kontaktsport mit harter, körperbetonter Spielweise entwickelt. Ob dies allerdings der Grund für mehr Verletzungen ist, ist fraglich, da sich viele Verletzungen ohne Einwirkung der Gegen- bzw. Mitspieler/innen ereignen. Dabei sind die unteren Extremitäten mit Sprunggelenksdistorsionen und Knieverletzungen häufiger betroffen als Muskel- und Fingerverletzungen. Das Schultergelenk ist pro Saison ungefähr 50.000 Wurfbewegungen ausgesetzt. Dadurch entstehen Folgen von Mikrotraumen, welche die muskuläre und bandhafte Sicherung schwächen, wenn es zu keinem Ausgleich von Belastung und Entlastung kommt. Es kommt zu Entzündungen an Muskelansätzen (Infraspinatussehne/Lange Bizepssehne/Rotatorenmanschette).

Ursachen für Verletzungen – Sind Frauen häufiger betroffen?

Wie in jeder Kontaktsportart ist auch im Handball die traumatische Einwirkung auf Gelenke und Sehnen-Muskelstrukturen einer der Hauptgründe für Verletzungen. Zerrungen des Muskel-Sehnenapparates, Prellungen, Luxationen, Zusammenstöße mit anderen Spielern sowie mehr oder minder schwere Fouls stehen an der Tagesordnung. Verletzungen ohne Fremdeinwirkung rangieren auf gleichem Niveau – mit steigender Tendenz.

Physische und psychische Überlastung:
Meist wird die psychische Komponente unterschätzt. Sportler/innen sind oft enormen Stresssituationen ausgesetzt, sei es von Seiten der Trainer/innen, Fans oder der Presse. Doch der größte Druck ist die Erwartungshaltung des Athleten an sich selbst. Um diesem gerecht zu werden, gehen die Spieler/innen oft über die verfügbaren Ressourcen hinaus. Höchstens ein bis zwei Jahre kann der Körper eine Mehrbelastung kompensieren, bevor die Aufrechterhaltung der Homöostase gestört wird. Offensichtlich ist, dass im Frauen-Handball Verletzungen häufiger auftreten als im Männerbereich. Dafür stehen mehrere Aspekte.

Anatomische & physiologische Unterschiede des Körperbaus:

Ursachen dafür, dass Frauen im Handball häufiger verletzt sind als Männer, sind unter anderem der anatomische Skelettaufbau sowie der Hormonhaushalt. So beschreibt der Orthopäde Dr. Steven K. Moyad die anatomischen Unterschiede zwischen einem männlichen Skelettaufbau und einem weiblichen, die bei einer sportlichen Belastung den Ausschlag für eine Ruptur des vorderen Kreuzbandes geben und somit Auswirkungen auf die gesamte Körperstruktur haben können (Higher risk of ACL tears in female athletes in general and with special reference to Handball). Die Beckenweitstellung einer Frau, welche für die Geburt notwendig ist, beeinflusst vor allem das Kniegelenk. Zwischen Tibia und Femur vergrößert sich der sogenannte Q-Winkel, wodurch die Gelenksicherung mehr beansprucht ist.

Einfluss des Hormonspiegels:
Als zweite große Komponente für das vermehrte Auftreten von Verletzungen im Frauen- und Mädchen-Handball ist der Einfluss des Hormonspiegels auf das Bindegewebe zu nennen. Das frühere Eintreten der Pubertät und die damit einhergehende Östrogen-Produktion beeinflusst einerseits den Aufbau der Knochenstruktur. Diese ist im Vergleich zu Männern um 25 Prozent leichter, was eine Hypermobilität der Gelenke zur Folge hat. Außerdem ist der Sehnen-Bandapparat weicher und flexibler und die Muskelmasse entspricht nur 36 Prozent des Gesamtkörpergewichts. Bei Männern liegt dieser Wert dagegen bei 45 Prozent. Daher ist bei Männern eine komplexere Gelenkstabilität gewährleistet.

Doppelbelastung durch Studium und Arbeit:
Im Frauen-Handball ist – wie in den meisten anderen Sportarten auch – deutlich weniger Geld zu verdienen als bei den Männern. Das geringere Gehalt ist ein  Grund dafür, warum fast alle Spielerinnen neben ihrem Sport eine Ausbildung, ein Studium oder eine ganz normale Arbeit mit 30 bis 40 Stunden pro Woche absolvieren. Oft haben Sport, Wettkampf und Training das Nachsehen, wenn beide Tätigkeiten nicht miteinander zu kombinieren sind. Dass Fitness und sportliche Leistung und Leistungsfähigkeit darunter leiden, steht außer Frage. Viele Spielerinnen verzichten auf eine Doppelbelastung, entscheiden sich gegen den Sport und für eine gesicherte berufliche Zukunft. So gehen viele Talente verloren.

Prävention und Rehabilitation: Eine Frage des Geldes?

Physiotherapeutische Betreuung:
Die meisten Handball-Vereine in der Frauen-Bundesliga können es sich finanziell nicht leisten, einen Teamarzt oder Physiotherapeuten fest anzustellen. Vor allem im Training fehlt deshalb im Falle einer Verletzung die professionelle Erstversorgung. Darüber hinaus steht den Spielerinnen kein Ansprechpartner zur Verfügung, der kleinere Blessuren behandeln und somit längere Verletzungspausen verhindern kann. Auch fehlt es an der nötigen Beobachtung, Beratung und Vorsorge. Ein Physiotherapeut beispielsweise könnte körperliche Schwachstellen (Fehlhaltungen, muskuläre Dysbalancen, Verkürzungen) erkennen und durch gezielte Maßnahmen eventuelle Sekundärschäden vermeiden.

Stabilisations- Koordinationstraining:
Es werden immer neue Trainingsmethoden vorgestellt, zur Verbesserung der Stabilität und Koordination. Fakt ist, dass die gelenkspezifische Propriozeption verbessert und geschult werden muss. Ein sensomotorisches Training bildet die Grundlage der Reflexwirkung von Muskel-Sehnenspindel und somit eine verbesserte unbewusste (automatisierte) Gelenkstabilität. Die Hauptmaßnahme stellt die Anzahl der Bewegungswiederholung dar – also das häufige Üben. Um Verbesserungen zu erzielen, sind Bewegungswiederholungen die ausschlaggebende Komponente. Auch wenn es wissenschaftlich nicht belegt ist, wird von 100.000 azyklischen Bewegungsabläufen ausgegangen. Dabei ist zu beachten, dass die Konzentration schrittweise vom Stabilisationsprozess abgelenkt wird, um eine Automatisierung der sensomotorischen Gelenkstabilität zu optimieren.

Nach Auswärtsspielen: Regeneration im Bus
Die Rehabilitation des Körpers findet zu 80 Prozent direkt nach der Belastung statt. In erster Linie geht es dabei um das optimale Auffüllen der Energiespeicher. Das allerdings ist im Bereich des Frauen-Handballs in Deutschland nur schwer möglich. Weil eine Doppelbelastung mit Arbeit und Studium an der Tagesordnung ist, werden die Hin- und Rückfahrten zu Auswärtsspielen in der Regel so kurzfristig organisiert, dass sie an einem Tag absolviert werden können. Dieser Stress wird den männlichen Kollegen nicht aufgebürdet, sie reisen zumeist am Tag zuvor an und am Tag danach wieder nach Hause. In einer sogenannten Englischen Woche (drei Spiele in sieben Tagen) führt die fehlende Regeneration deshalb zu „schweren Beinen“ und manchmal auch zu Stressreaktionen und Verletzungen.

Über die Autorin:
Sonja Frey
ist Handballerin im Frauen-Bundesligateam des Thüringer HC. Die in Wien geborene vielfache österreichische Nationalspielerin spielt seit 2012 bei dem Verein aus Erfurt, mit dem sie 2013, 2014 und 2015 die deutsche Meisterschaft sowie 2013 den DHB-Pokal gewann. Neben dem Handball absolviert die Topspielerin, die in bislang 54 Länderspielen 234 Tore erzielte, eine Ausbildung zur Physiotherapeutin und steht unmittelbar vor dem Examen.

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