Sehr geehrte Damen und Herren,
vom 1. bis 17. Mai kämpfen die besten Eishockey-Nationalmannschaften in Tschechien um den Weltmeistertitel. Das rasante und bisweilen überharte Spiel, das als schnellste Mannschaftssportart der Welt gilt, zieht die Zuschauer in seinen Bann, birgt aber trotz Schutzkleidung mit Helm und Rüstung einige Verletzungsrisiken. Warum die Maßnahmen zum Schutz der Spieler nicht immer ausreichen, wie manche Akteure die Wirksamkeit der Protektoren beeinträchtigen und warum den Schiedsrichtern beim Thema Prophylaxe eine besondere Bedeutung zukommt, beschreibt dieser Newsletter.
Der 30. Jahreskongress der GOTS findet am 12. und 13. Juni 2015 erstmals in der Schweiz statt. Das ausführliche wissenschaftliche Programm der Veranstaltung im Congress Center in Basel sowie weitere Information und die Kongressregistrierung finden Sie unter: www.gots-kongress.org
Herzliche Grüße,
Ihr Andreas Bellinger (presse@gots.org)
Kontaktsport und Verletzungsprävention: Ein Widerspruch?
Eishockey ist der wohl schnellste Mannschaftssport der Welt. Doch trotz der harten Zweikämpfe mit heftig anmutenden Checks auch an der Bande ist das Verletzungsrisiko nicht einmal so groß wie beispielsweise beim Basketball, das nur scheinbar ein körperloses Spiel ist. Ein Grund dafür sind die im Eishockey durch das Regelwerk vorgeschriebenen Protektoren. Doch nicht bei allen der harten Kerle ist die Schutzkleidung unumstritten; für den ein oder anderen ist sie schlicht „uncool“ oder „unmännlich“. Aber natürlich sind auch bei der am 1. Mai in Prag und Ostrava beginnenden Eishockey-Weltmeisterschaft, bei der neben den heimstarken Tschechen wie üblich Schweden, Kanada, Russland und Finnland zu den heißen Favoriten zählen, Protektoren Pflicht.
Kopfverletzungen ein zunehmendes Problem
Obwohl Eishockey in den Verletzungsstatistiken nicht im Vorfeld platziert ist, gibt es ein zunehmendes Problem mit traumatischen Kopfverletzungen. Das Siegerlächeln ist oftmals ein zahnloses, weil eine Kultur übertriebener Männlichkeit vorherrscht. Dabei könnten schon einfache Maßnahmen helfen, den schnellsten Mannschaftssport der Welt noch sicherer zu machen.
Mit Geschwindigkeiten von bis zu 50 Kilometern pro Stunde rasen die Spieler auf ihren Schlittschuhen über das Eis und müssen sich überdies der Angriffe des Gegners erwehren. Der rund 160 Gramm schwere Puck wird bis zu 160 Sachen schnell. Aufgrund der großen auftretenden Kräfte liegt es in der Natur des Spiels, dass es immer wieder zu Verletzungen kommt. Diese passieren zu 75 Prozent im Wettkampf und zu 25 Prozent im Training. Die Verletzungen entstehen zum Großteil durch Kontakt mit dem Gegner, aber auch beim Aufprall an die Bande oder das Torgestänge. Angriffsspieler sind dabei häufiger von Verletzungen betroffen als Verteidiger und Torhüter. Am häufigsten sind Verletzungen der Knie (40 Prozent) und der Schultern (20 Prozent), gefolgt von Leisten- und Rückenproblemen.
Verletzungsrisiko geringer als beim Basketball
Der Verletzungsfaktor beim Eishockey ist in Relation zu anderen Sportarten aber gering: Er beträgt beispielsweise für Rugby 35, für Basketball 9,2 und für Volleyball 3,1 – erst danach folgt Eishockey mit 2,9 (K. Steinbrück). Grund für diesen guten Wert, der manchen überraschen mag, ist das für jeden Spieler zwingend vorgeschriebene Tragen einer Schutzausrüstung. Für Verbände und Vereine, aber auch für die betreuenden Ärzte ist es von großer Bedeutung, dass diese Schutzausrüstung regelkonform zum Einsatz kommt und entsprechend weiterentwickelt wird.
Zu einem Problem kann in der Praxis werden, dass Spieler nicht selten stabilisierende Teile der sogenannten Protektoren eigenhändig herausschneiden, weil sie sich in ihrer Bewegungsfreiheit einschränkt fühlen – etwa in der Hose, im Brust- oder im Schulterschutz. Dadurch entstehen allerdings neue Angriffsflächen, vor allem an Hüfte, Schulter und Brustkorb.
Ein weiterer Schwachpunkt sind die Schlittschuhe. Trotz großer Härte der Materialien kommt es durch den Aufprall des Pucks immer wieder zu Brüchen am Sprunggelenk und an den Füßen. Spezielle Protektoren aus Carbon oder Plastik können die Aufprallkräfte minimieren. Vor allem Verteidiger benutzen oft diese zusätzlichen Schützer, die allerdings den Schuh etwas verbreitern, was wiederum zur Folge hat, dass der Spieler in steilen Kurvenlagen frühzeitig Kontakt mit dem Eis bekommt. Stürze sind dann nicht selten die Folge.
Vollvisier könnte Verletzungen verhindern
Das ohnehin schon schnelle Spiel wird noch schneller. Die Physis der Spieler wird immer besser. Das heißt, Eishockey verändert sich, und somit wären Regelanpassungen wichtig, um Verletzungen vorzubeugen. Besonders wichtig ist dabei der Schutz des Kopfes, der natürlich besonders gefährdet ist. Bis zur Einführung der Helmpflicht 1979 war es für viele Spieler unvorstellbar, einen Helm zu tragen. Heute ist die Helmpflicht völlig normal. Die Verwendung eines Vollvisierhelms mit schützendem Gitter ist allerdings nur bis zum 18. Lebensjahr und im Frauen-Eishockey vorgeschrieben. Sobald sie alt genug sind, entfernen praktisch alle Männer das schützende Gitter, obwohl damit freiwillig ein wirkungsvoller Schutz preisgegeben wird.
Für Mediziner ist das völlig unverständlich, da durch ein Vollvisier alle Mittelgesichtsbrüche und die vielen Rissquetschwunden im Gesicht vermieden werden könnten. Auch würden die entstellenden Zahndefekte ausbleiben. Doch diese Argumente zählen nicht, solange es im Eishockey immer noch als „uncool“ oder „unmännlich“ gilt, einen Vollvisierhelm zu tragen. Die Spieler behaupten, das Gitter störe die Sicht. Außerdem würden Spieler, die einen solchen Helm tragen und somit weniger Angst vor Gesichtsverletzungen haben, noch wilder agieren. Warum aber bestreiten dann Eishockeyspieler nach Operationen bis zu ihrer Ausheilung Spiele mit Gitter und spielen damit auch nicht schlechter oder brutaler? In Wahrheit ist die fehlende Akzeptanz, ein Vollvisier zu tragen, das Problem.
Bleibende Schäden bei bis zu 15 Prozent
Jedoch schützt auch das Gitter nicht vor traumatischen Erschütterungen des Kopfes:
Ähnlich wie im American Football rücken „mild Traumatic Brain Injuries“ (mTBI) und „Sports Related Concussions“ (SRC) immer mehr ins Zentrum der Aufmerksamkeit. Solche Verletzungen entstehen durch ein stumpfes Trauma gegen den Kopf oder durch beschleunigende beziehungsweise bremsende Kräfte auf Kopf und Halswirbelsäule. Zur Evaluierung ist eine neuropsychologische Testung nötig. Die Erholungsphase nach der Erstverletzung beträgt in der Regel 7 bis 14 Tage, und die meisten Betroffenen erholen sich vollständig. Das Krankheitsbild ist in vielen Arbeiten publiziert. Die Daten werden mit dem SCAT (Sport Concussion Assessment Tool) erfasst, und es gibt ein definiertes „Return to play-Protokoll“.
Die Wahrscheinlichkeit, pro 1000 Spielstunden diese Verletzung zu erleiden, liegt in der amerikanischen Eishockey-Profiliga NHL zwar „nur“ bei 1,5; während sie im australischen Football 4,2, im Profiboxen 13,2 oder beim Springreiten sogar 25,0 beträgt. Studien weisen aber nach, dass bis zu 15 Prozent der Patienten bleibende Probleme wie chronische Kopfschmerzen, Gedächtnisprobleme oder Stimmungsschwankungen haben. Nach drei- bis viermaliger Verletzung sind bleibende Langzeitschäden mit hoher Wahrscheinlichkeit vorhanden. Pro Jahr gibt es etwa 1,6 bis 3,8 Millionen gezählte SRC-Verletzungen im Profisport (Journal of Athletic Training Center 2007), wobei die Dunkelziffer weit höher ist. Laut einer retrospektiven Studie bleiben 88 Prozent aller Fälle unerkannt!
Ohne Regeln nutzen Protektoren nichts
Viele Verletzungen passieren durch einen Anprall an die Bande. Diesbezüglich gibt es Versuche, Spielrandbegrenzungen flexibler zu gestalten und somit die Aufprallkräfte zu minimieren. Das regelkonforme Tragen einer Schutzausrüstung ist vorgeschrieben. Gebrochene Teile, alte, gebrauchte Protektoren und Ausrüstungsgegenstände sind auszutauschen – und die Ausrüstung muss richtig und fest angelegt werden. Beim Verrutschen der Schutzausrüstung kann es durch den direkten Aufprall von Körperteilen auf das Eis zu schlimmen Verletzungen kommen.
Jugendtrainer haben eine wichtige Ausbildungsfunktion. Unter anderem müssen sie ihren Schützlingen das richtige Anlegen und die Wertigkeit einer gut funktionierenden Schutzausrüstung vermitteln. Wer von klein auf lernt, dass Helm und Protektoren gut und fest sitzen müssen, wird diese ihrer Funktion entsprechend anlegen und sich unsicher fühlen, wenn er das nicht tut.
Auch die besten Protektoren sind jedoch umsonst, wenn die Referees das Spiel nicht streng regelkonform leiten. Der Entwicklung im modernen Eishockey Rechnung tragend, sind sie als Verantwortliche für die Einhaltung der Spielregeln ein verantwortungsvoller Baustein zur Wahrung der Sicherheit der Sportler.
Über den Autor:
Dr. Gerhard Oberthaler ist Facharzt für Unfallchirurgie und Sportarzt in Salzburg, Teamarzt des Eishockeyclubs EC Red Bull Salzburg, des Österreichischen Eishockeyverbandes und des Österreichischen Skiverbandes sowie GOTS-Vizepräsident Österreich.
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