Gesellschaft für Orthopädisch-Traumatologische Sportmedizin

Medizinische Probleme durch die Verschiebung der Olympischen Spiele?

Die Corona-Pandemie hat weltweit den internationalen Sportkalender außer Kraft gesetzt. Auch die Olympischen Spiele 2020 mussten verschoben werden. Ursprünglich sollten sie vom 24. Juli bis zum 9. August 2020 stattfinden, doch aufgrund der sich seit Anfang 2020 weltweit ausbreitenden SARS-CoV-2-Pandemie wurden sie um fast genau ein Jahr verschoben (5). Einige Mannschaften hatten zum Zeitpunkt der offiziellen Bekanntgabe der Verschiebung ihre Teilnahme für die Olympischen Spiele 2020 bereits abgesagt (1,2). In zahlreichen Ländern kam es im Frühjahr 2020 zu massiven Einschränkungen des öffentlichen Lebens und somit auch der Sport- und Trainingsmöglichkeiten. Es ist das erste Mal, dass Olympische Sommerspiele nicht im turnusmäßigen Rhythmus von vier Jahren stattfinden, wenn man von den abgesagten Spielen während der beiden Weltkriege absieht. Die Olympischen Spiele 2020 sollen nun vom 23. Juli bis zum 8. August 2021 in Tokio stattfinden und auch weiter unter dem Namen “Tokio 2020” abgehalten werden (3,4). Nach 1964 richtet Tokio zum zweiten Mal Olympische Spiele aus.

Die gemeinsame Entscheidung des Internationalen Olympischen Komitees (IOC) und des japanischen Organisationskomitees, die Olympischen Spiele angesichts der Corona-Pandemie ins Jahr 2021 zu verlegen, entspricht laut dem DOSB auch dem Stimmungsbild der Mehrheit von Team Deutschland. In einer Umfrage des Deutschen Olympischen Sportbundes (DOSB) unter den Athleten, die von ihren Verbänden für die Longlist für Tokio 2020 gemeldet waren, sprachen sich kurz vor der Entscheidung des IOC rund 95 Prozent für eine Verlegung auf einen späteren Zeitpunkt aus. Befragt wurden hierbei 1409 Athleten, von denen sich schließlich 808 Sportler aus 35 Sportarten an der Umfrage beteiligten (5).

Die Frage, ob sie an den Spielen zum geplanten Termin vom 24. Juli bis 9. August 2020 teilgenommen hätten, bejahten 43,4 Prozent. Zusätzlich bestätigten 20,6 Prozent, dass sie nur unter gewissen Voraussetzungen teilgenommen hätten, wie zum Beispiel, dass Corona kein Risiko mehr darstelle, die Gesundheit für alle gesichert sei und die WHO Grünes Licht gegeben hätte. Außerdem wurden ausreichende Schutzmaßnahmen vor Ort ebenso gefordert wie eine medizinische Überprüfung aller Teilnehmenden von Athleten bis zu allen Volunteers. Als weitere wichtige Voraussetzung benannten die Athleten die Wiederaufnahme weltweiter Dopingkontrollen, eine ausreichende Vorbereitungszeit mit entsprechenden Trainingsmöglichkeiten, um die Chancengleichzeit zu wahren sowie eine Anpassung der Qualifikationsmöglichkeiten (5).

Bei allen Fragen sind unterschiedliche Einschätzungen in Abhängigkeit vom Qualifikationsstatus festzustellen. Bereits qualifizierte Athleten, die relativ sicher einen Quotenplatz ihres Verbandes innehaben, hätten beispielsweise in größerer Zahl auf jeden Fall an den Spielen teilgenommen. Athleten, die sich noch über Wettbewerbe qualifizieren müssen oder für sich keine reale Chance auf eine Qualifikation sehen, dagegen in deutlich geringerer Zahl (5).

Bei der Betrachtung der Auswirkungen der Verschiebung der Olympischen Spiele aus medizinischer Sicht, geht es eher um die Auswirkungen der SARS-CoV-2-Pandemie auf den Sport und die hieraus resultierenden Probleme und weniger um die Olympischen Spiele selbst. Die Probleme einer möglicherweise stattgehabten oder durchgemachten COVID-19 Infektion eines Athleten sollen im Weiteren nicht aufgegriffen werden. Die DGSP und die medizinische Kommission des DOSB haben hierzu in einem Positionspapier ausführlich und detailliert Stellung genommen (6).

Bei der Umfrage des DOSB wurde ebenfalls deutlich, dass die Trainingssituation vieler Athleten eine gute Vorbereitung auf das weltweit größte Sportereignis nicht mehr zugelassen hätte. 14,8 Prozent der Athleten hatten zum Zeitpunkt der Umfrage das Training bereits komplett eingestellt, zudem gaben mehr als die Hälfte der Befragten (51,6 Prozent) „extrem eingeschränkte Trainingsmöglichkeiten“ und weitere 27,1 Prozent „teilweise eingeschränkte Trainingsbedingungen“ an. Nur 6,5 Prozent konnten unter gleichen Bedingungen wie gewohnt trainieren. Es hat sich gezeigt, dass dabei die Trainingsmöglichkeiten für bereits Qualifizierte und Athlet*innen, die noch gute Chancen auf eine Qualifikation hatten, besser waren als für jene, die ihre Qualifikationschancen als gering einstuften (5).

Besondere Aufmerksamkeit hat das Thema der eingeschränkten Trainings- und Wettkampfmöglichkeiten im Fußball erlangt. Einige der Probleme aus dem Fußball können als exemplarisch für mögliche – auch medizinische- Probleme und Gefahren in anderen Sportarten gelten.

 

 

 

 

 

 

 

 

 

 

Es wurden aus Gründen des Infektionsschutzes zahlreiche Hygienemaßnahmen zur Wiederaufnahme der Bundesliga getroffen. Man kann jedoch auch besorgt darüber sein, dass die Spieler mit dem Wiedereinstieg in den Spielbetrieb gegebenenfalls einem weitaus höheren Risiko von Verletzungen ausgesetzt sind als gewöhnlich (7).

Inzwischen ist es den Teams nach mehreren Monaten ohne Spielpraxis wieder möglich unter (einigermaßen) normalen Umständen zu trainieren. Davor war es Heimtraining, Training im Fitnessstudio und schließlich Training in Kleingruppen. Jedoch entspricht nichts hiervon dem regulären Training, das normalerweise in der Vorsaison absolviert wird.

Wir müssen davon ausgehen, dass sich nicht jeder Fußballer, Athlet bzw. Sportler in den Kleingruppen oder im Heimtraining gleich gut vorbereitet und gearbeitet hat bzw. überhaupt die Möglichkeiten dazu hatte. Die Leistungsfähigkeit und die Belastbarkeit könnten bei vielen reduziert sein und damit das potentielle Verletzungsrisiko steigen (8).

Die Verletzungsanfälligkeit steigt jedoch mit hohen Belastungen, wie sie beispielsweise im Wettkampf auftreten. Es bleibt somit abzuwarten, ob es – beispielsweise gegen Ende des Spiels – zu einer erhöhten Inzidenz von Verletzungen kommen wird. Geringere Leistungsfähigkeit, Fitness und Widerstandsfähigkeit bedeuten ein höheres Risiko für das Auftreten einer Verletzung, dies könnte insbesondere auch unterklassige Mannschaftssportarten treffen, wenn diese wieder in den Spielbetrieb gehen werden

Für viele Sportarten, insbesondere Spiel- und Kontaktsportarten, gilt, dass gut entwickelte physische Qualitäten mit einem verringerten Verletzungsrisiko einhergehen (9). Um diese körperlichen Fähigkeiten entwickeln zu können und eine Schutzwirkung gegen Verletzungen aufzubauen, muss hart trainiert werden, sodass auch wiederkehrende hohe Belastungsspitzen, wie sie insbesondere im Wettkampf/Spielbetrieb auftreten, verletzungsfrei absolviert werden können. Auf der anderen Seite gibt es Hinweise dafür, dass zu wenig Training das Verletzungsrisiko erhöhen kann. Insbesondere in den Spielsportarten besteht also die Notwendigkeit einer ausgeprägten Fitness und Widerstandsfähigkeit.

Das ‘Training-Injury Prevention Paradox’ Model nach Gabbett beschreibt ein Phänomen, bei dem Sportler, die an hohe Trainingsbelastungen adaptiert sind, weniger Verletzungen aufweisen als Sportler, die mit geringerer Belastung trainieren (9).

Für “non contact” Verletzungen wissen wir, dass diese nicht durch Training an sich, sondern eher durch “unangemessenes” Training begünstigt werden. Übermäßig und schnell steigende Trainingsbelastungen sind wahrscheinlich verantwortlich für einen großen Anteil von “non contact” Weichteilverletzungen (Muskelverletzungen, Kreuzbandverletzungen etc.). Die von Tim Gabbett vorgestellte Variable “acute vs. chronic workload ratio” kann aktuell als Best-Practice-Prädiktor für trainingsbedingte Verletzungen eingesetzt werden (9). Auf dieser Grundlage lassen sich Interventionen zur Reduktion des Verletzungsrisikos und dem damit verbundenen “time loss” durch Verletzungen entwickeln. Betrachtet man diese “acute vs. chronic workload ratio” für die Zeit während und nach der Corona-Pandemie, so kann vermutet werden, dass gute bzw. gewohnte Trainings- und Leistungsdaten aufgrund der eingeschränkten Monitoring-Möglichkeiten nicht konsistent vorliegen. Für die Trainings- und Belastungssteuerung fehlen also potentiell notwendige Daten.

Insbesondere in den Spiel- bzw. Mannschaftsportarten wird mit dem Wiedereinstieg in den Wettkampfbetrieb zwangsläufig die Gefahr der sehr schnell gesteigerten Belastung entstehen.  Ein abgestuftes Konzept von Grundlagentraining und sukzessive höheren Trainingsbelastungen sollte letztendlich die Fitness der Athleten verbessern. Dies wiederum kann vor Verletzungen schützen und führt somit schließlich zu einer höheren physischen Leistungsfähigkeit und Belastbarkeit im Wettkampf. Unter den gegebenen Umständen der verkürzten oder kaum vorhandenen Saisonvorbereitung im Zuge der Corona-Pandemie ist ein solches Aufbaukonzept nicht gegeben.

Auf der Webseite “trackademicblog.com” werden unterschiedliche Auswertungen zur Bundesliga, der Premier League und La Liga zu Verfügung gestellt.

Am 20. Juni wurden für den 33. Spieltag (Spieltag 8 nach dem Lockdown) vier Verletzungen in der laufenden Spielwoche registriert. Dies bringt die “overall post-lockdown injury rate” auf 0.58 Verletzungen pro Spiel. Eine erhebliche Zahl kleinerer Verletzungen treibt die “overall time-loss” Zahlen zusätzlich nach oben (Abb. 1) (10).

Für diejenigen, die die Rückkehr in den Elitesport in den kommenden Monaten planen, kann der “Fall” eines der Bundesliga-Zweitligisten als warnendes Beispiel dienen.

Nach dem Lockdown sollte der Club am 17. Mai wieder in Aktion treten. Nach der Bestätigung von zwei COVID-19 Fällen am 8. Mai wurde die gesamte Mannschaft für zwei Wochen in Quarantäne geschickt, während andere Clubs ihre Vorbereitungen fortsetzen konnten. Mit deutlich weniger Vorbereitungszeit musste somit der Wiedereinstieg in den Spielbetrieb umgesetzt werden. Hinzu kam, dass der Club alle 3,3 Tage ein Spiel absolvieren sollte (einschließlich einer Phase mit 7 Spielen in 19 Tagen, was zu einem Spiel alle 2,7 Tage führte). Andere Clubs spielten hingegen alle 4,9 Tage und hatten mehr als die doppelte Vorbereitungszeit. In weniger als einem Monat haben fünf Spieler des Zweitligisten Verletzungen erlitten, die zu einem “time loss” von jeweils mindestens zehn Tagen geführt haben. Mindestens drei weitere, jedoch kleinere Verletzungen haben ebenfalls zu einem “time loss” geführt (10).

Einige Daten aus den Auswertungen dienen als Surrogatparameter für den Trainings- und Fitnesszustand der Spieler des Zweitliga-Clubs und sind sicherlich suggestiv, implizieren allerdings, dass neben reduzierten “Messwerten” auch weitere potentielle Verletzungsprädiktoren zu berücksichtigen sind (Abb. 2) (10).

Die Frage, die bleibt, ist ob wir als indirekte Folge der Corona Pandemie, der Wettkampfverschiebungen und der erheblichen Einschränkung im Sport, im Training und in der Vorbereitung auf die Wettkampfsaison aufgrund der reduzierten “Fitness” und Widerstandsfähigkeit mit einer steigenden Zahl von Sportverletzungen konfrontiert werden.

Aus Präventionssicht müssen sich Trainerstab und Athleten dieser Problematik bewusst sein, die Vorbereitung sorgfältig planen und auf ein ausgewogenes Maß von Grundlagentraining und Spezifik in Vorbereitung auf den Wiedereinstieg in das Wettkampfgeschehen achten.

GOTS. „we care for sports“

 

Abb. 1. Verletzungszahlen in der Bundesliga in Bezug auf den Lockdown. Mod. nach (10)

 

 

CATEGORY PRE-LOCKDOWN PER GAME POST-LOCKDOWN PER GAME % CHANGE
POINTS 0.92 0.88 -4.3%
GOALS 1.00 0.63 -37,0%
GOALS CONCEDED 1.64 1.88 +14.6%
POSSESION 52% 44.5% -7.5%
DISTANCE COVERED 113.6KM 109.4KM -3.7%
SPRINTS 197.6 176.0 -10.9%

 

Abb. 2: Spielauswertungen für einen Zweitligaverein vor und nach der Lockdown-Phase. Mod. nach (10)

 

Literatur

 

  1. Coronavirus Live Updates: Canada Threatens Olympics Boycott; Trump Authorizes National Guard, The New York Times (abgerufen 25.03.2020)

 

  1. Australia’s Olympians told to prepare for Games to be held in 2021, smh.com.au vom 23.03.2020

 

  1. Olympische Spiele in Tokio auf 2021 verschobenSportschau, (abgerufen am 23.03.2020)

 

  1. Olympische Spiele werden verschoben. In: tagesschau.de, 24. März 2020 (abgerufen am 24.03.2020)

 

  1. https://www.dosb.de/sonderseiten/news/news-detail/news/athleteninnen-von-team-d-befuerworten-olympia-verlegung/ (abgerufen 25.06.2020)

 

  1. Nieß AM, Bloch W, Friedmann-Bette B, Grim C, Halle M, Hirschmüller A, Kopp C, Meyer T, Niebauer J, Reinsberger C,Röcker K, Scharhag J, Scherr J, Schneider C, Steinacker JM, Urhausen A, Wolfarth B, Mayer F. Position stand: return to sport in the current Coronavirus pandemic (SARS-CoV-2 / COVID-19). Dtsch Z Sportmed. 2020; 71: E1-E4. doi:10.5960/dzsm.2020.437

 

  1. https://www.dw.com/en/coronavirus-are-bundesliga-players-at-higher-risk-of-injury-on-return/a-53418201. (abgerufen 25.06.2020)

 

  1. https://www.trackademicblog.com/blog/loading-under-lockdown-what-the-science-says-about-detraining-and-how-to-prioritise-in-a-pandemic (abgerufen 25.06.2020)

 

  1. Gabbett TJ. The training—injury prevention paradox: should athletes be training smarter andharder? British Journal of Sports Medicine 2016;50:273-280.

 

  1. https://www.trackademicblog.com/blog/thesnapshotbecomesastory (abgerufen 25.06.2020)

 

DIE AUTOREN

 

Dr. med. Casper Grim

Chefarzt der Klinik für Orthopädie und Sportmedizin

Osnabrücker Zentrum für muskuloskelettale Chirurgie (OZMC)

Vizepräsident Deutschland der GOTS

Leitender Verbandsarzt der Deutschen Triathlon Union (DTU)

Leitender Orthopäde der Deutschen Olympiamannschaft bei den Olympischen Spielen Rio 2016

 

 

Prof. Dr. med. Bernd Wolfarth,

Ordinarius für Sportmedizin an der Humboldt-Universität zu Berlin

Leiter der Abteilung Sportmedizin der Charité Universitätsmedizin Berlin

Leiter Fachbereich Sportmedizin, Institut für Angewandte Trainingswissenschaft, Leipzig.

Leitender Verbandsarzt des Deutschen Skiverbandes

Leitender Olympiaarzt des Deutschen Olympischen Sportbundes

 

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