Gesellschaft für Orthopädisch-Traumatologische Sportmedizin

Reminder: GOTS-Pressekonferenz heute um 13.15 Uhr + Thema Eishockey

Heute beginnt in München der 29. GOTS-Jahreskongress
Pressekonferenz um 13.15 Uhr: Leistungssport und Wissenschaft – oder:
Warum darf ein Profi-Fußballer viel eher wieder auf den Platz als der Freizeitkicker?

Heute beginnt in München der 29. GOTS-Jahreskongress. Die Pressekonferenz um um 13.15 Uhr beschäftigst sich schwerpunktmäßig mit dem Thema „Leistungssport und Wissenschaft“. Dabei geht es unter anderem um die häufig diskutierte Frage: Warum darf ein Profifußballer bei einer Verletzung schon nach wenigen Tagen wieder auf den Platz, während dem Freizeitkicker eine monatelange Pause verordnet wird?

Pressekonferenz „Leistungssport und Wissenschaft“
Freitag, 20. Juni 2014, 13.15 Uhr

Hotel Hilton Munich Park
Salon Dali/Picasso
Am Tucherpark 7
80538 München

Auf dem Podium erwarten Sie:

Armin Veh (Trainer Eintracht Frankfurt / ab 1.7. VfB Stuttgart)
Dr. Raymond Best (Mannschaftsarzt VfB Stuttgart)
Prof. Dr. Dr. Victor Valderrabano (GOTS-Präsident)
Prof. Gerhard Bauer (Kongresspräsident)
Dr. Christian Schneider (Vertreter der Verbandsärzte)

Das detaillierte Kongressprogramm finden auf der Website des Kongresses (gots-kongress.org).

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

Eishockey aus sportmedizinischer Sicht

Vom 9. bis 25. Mai 2014 fand die 78. Eishockey-Weltmeisterschaft der Herren in der weißrussischen Hauptstadt Minsk statt. Unter den 16 teilnehmenden Nationalteams der Top-Division hatte sich auch Deutschland qualifiziert. Nach einem guten Start mit zwei Siegen hagelte es aber im Anschluss fünf Niederlagen in Folge für das deutsche Team, unter anderem gegen den späteren Weltmeister aus Russland. Wer die rauen Kämpfe auf dem Eis um Tore und Siege gesehen hat, mag sich vielleicht wundern, dass Verletzungen der Spieler weniger häufig sind, als man als Zuschauer vermutet.

Eishockey ist die schnellste Mannschaftssportart der Welt. Bis zu 50 Kilometer pro Stunde Laufgeschwindigkeit werden durch das Powerskaten erreicht. Der Puck mit einem Gewicht von etwa 160 Gramm erreicht gar Geschwindigkeiten von bis zu 160 Kilometern pro Stunde. Aufgrund der hohen Geschwindigkeiten, kombiniert mit dem äußerst körperbetonten Spiel, gilt Eishockey als besonders harter Sport. In den Verletzungsstatistiken ist Eishockey jedoch nicht auf den vorderen Rängen platziert, sondern liegt unter anderem sogar hinter Fußball und American Football.

Anforderungen an den Sportler

Die hohe Spielgeschwindigkeit erfordert vom Eishockeyspieler eine sportarztspezifische Schnelligkeits- und Kraftausdauer, um den intensiven zyklischen und azyklischen Bewegungsabläufen gerecht zu werden. Zudem ist Spielwitz aufzubringen und der Spieler muss sich rasch auf unterschiedliche Situationen einstellen können. Ein hohes Niveau an Grundlagenausdauer ist außerdem vonnöten, um sich in den Pausen ausreichend erholen zu können. Mit einsetzender Ermüdung und somit Konzentrationsverlust nimmt die Verletzungshäufigkeit überproportional zu. Kollisionen mit dem Gegenspieler und der Bande sind für einen Großteil der Verletzungen verantwortlich.

Neben Trainingszustand, Spielverständnis beziehungsweise Disziplin des Akteurs sind es vor allem die Ausrüstung und das richtig angewandte Regelwerk, die das Verletzungsrisiko minimieren können. Durch moderne Ausrüstungstechnik und bessere Schulung der Schiedsrichter ließ sich die Verletzungsgefahr durch Zunahme der Athletik, Schnelligkeit und Aggressivität in den letzten Jahren egalisieren.

Epidemiologie und Lokalisation der Verletzungen und Beschwerden

Etwa 80 Prozent der Verletzungen beim Eishockey werden  durch ein akutes Trauma hervorgerufen, 20 Prozent sind Überlastungsschäden. 75 Prozent der Verletzungen ereignen sich im Spiel und nur circa 25 Prozent im Training. Dabei sind Angriffsspieler insgesamt häufiger verletzt. Laut Literatur sind Knieverletzungen die häufigste Ursache für die Spielunfähigkeit (40 Prozent), gefolgt von Verletzungen der Schulter (Prellungen, Verrenkungen, Schultereckgelenksverletzungen) mit circa 20 Prozent. Leistenverletzungen (15 Prozent) und Rückenverletzungen (10 Prozent) sind zudem Gründe für eine Spielunfähigkeit.

An den unteren Extremitäten kommen vor allem Bänderverletzungen des Kniegelenks und hier besonders des Innenseitenbandes häufig vor. Oft ist eine Dauerversorgung mittels Knieschiene (Orthese) sinnvoll. Die zweithäufigsten Verletzungen der unteren Extremitäten sind Verletzungen am Fuß sowie am oberen Sprunggelenk, hier vor allem Brüche durch direkte Pucktreffer, aber auch Bandverletzungen im Sprunggelenksbereich. Verletzungen im Hüftbereich sind vorwiegend Prellungen und Zerrungen. An den oberen Extremitäten sind neben den Schulterverletzungen Unterarmbrüche und Brüche der Finger durch Stockschläge möglich. Bei Verletzungen der Wirbelsäule handelt es sich vorwiegend um Prellungen.

Verletzungen am Kopf und SRC (sports related concussion)

Bei Verletzungen am Kopf während eines Eishockey-Spiels handelt es sich zumeist um Platz- oder Rissquetschwunden ohne knöcherne Beteiligung, die häufig vor Ort versorgt werden können. Pucktreffer im Halsbereich können zu einer akuten Luftnot führen, die eine absolute Notfallsituation darstellt und ein rasches medizinisches Eingreifen notwendig macht.

Etwa fünf Prozent der Spieler erleiden pro Saison eine SRC (sports related concussion). Dabei ist insbesondere die „milde“ Gehirnerschütterung (mTBI) oft schwierig zu diagnostizieren. Häufig sind lediglich Symptome wie Müdigkeit und Unwohlsein sowie ein verzögertes Reaktionsvermögen vorhanden. Besonders gefährlich ist, wenn dieser Zustand nicht erkannt wird und der Spieler aufgrund des verminderten Reaktionsvermögens bei neuerlichem Einsatz eine zusätzliche Verletzung erleidet. Repetitive SRCs können bleibende Schäden nach sich ziehen und zur Sportunfähigkeit führen.

Die Rückkehr zum Sport muss nach einem strengen Rehabilitationsprogramm (siehe Tabelle) erfolgen, das in sechs Stufen abläuft (SCAT2). Neuerliche Symptome dürfen bei steigernder Belastung nicht auftreten, sonst muss eine Stufe zurückgegangen werden, pro Stufe nur ein Tag heißt die Devise.

Prävention von Verletzungen beim Eishockey

Wichtig zur Verletzungsprophylaxe ist eine gezielte Saisonvorbereitung, insbesondere im konditionellen und Kraft-Bereich mit Fokus auf die Bauch- und Rückenmuskulatur (Core- Stabilisierung). Des Weiteren muss die Schutzkleidung regelkonform und gut angelegt werden und voll funktionsfähig sein, defekte Schutzausrüstung muss ausgetauscht werden. Auch eine korrekte Ausbildung der Schiedsrichter ist von enormer Bedeutung. Die Regeln beim Eishockey werden zunehmend dahingehend verändert, dass der Schutz der Gesundheit der Spieler über allem steht. Um auf Verletzungen zu reagieren, hat der Weltverband neue Strafen eingeführt, die helfen sollen, schwere Verletzungen zu vermeiden. Auf einen Check gegen den Kopf- und Nackenbereich sowie einen Check von hinten folgt eine Bestrafung mit einer persönlichen Disziplinarstrafe (2+10 Minuten).

Die Eishockey-Schuhe müssen dem Fuß angepasst werden, damit es zu keinen Druckstellen oder Geschwüren kommt. Zur Prophylaxe können speziell angefertigte Socken mit eingebauten Silikonpelotten getragen werden. Schuhprobleme müssen rechtzeitig erkannt werden und sind in ihrer initialen Phase oft noch leicht therapierbar. Bei Nichtbeachtung kann es hingegen zu chronischen Problemen mit offenen Hautarealen und Wundheilungsstörungen kommen, die eine lebenslange Problematik bei der Sportausübung nach sich ziehen können.

Es besteht im Erwachsenen-Eishockey lediglich eine Halbvisierpflicht, eine allgemeine Helmpflicht gibt es seit 1979. Durch das Tragen von Gitterhelmen oder Vollvisieren ließen sich Verletzungen im Gesicht praktisch völlig vermeiden. Viel bedeutsamer wäre aber, dass  Gesichtsschädelbrüche (Kiefer, Nasenbein etc.) eine Seltenheit würden. Solche Verletzungen müssen häufig operiert werden und verursachen eine lange Spielpause. Ein weiterer Aspekt wäre, dass das große Problem des „Zähne-Verlierens“ gelöst wäre. Für mich als betreuender Arzt ist es unverständlich, warum die Vollvisierpflicht beim Eishockey noch nicht generell eingeführt wurde. Viele Vereine würden enorm viel Geld sparen, da es zu keinem Ausfall ihrer Spieler kommt. Auch würden die einmal für viel Geld regulierten Zähne erhalten bleiben.

Das Tragen eines Mundschutzes schützt nur ungenügend vor Zahnverletzungen und hat bei Jugendspielern keine Minimierung der Gehirnerschütterungen gebracht. Die Gesichtsschädel- und Zahnverletzungen sind jedoch in der „Eishockey-Community“ als „part of the game“ akzeptiert.

Die Rolle des Teamarztes

Beim Teamarzt müssen alle medizinischen Informationen zusammenlaufen. Er ist wichtiger Koordinator zwischen den medizinischen Fachrichtungen, den Fitness-Coaches, Physiotherapeuten, Masseuren, den Trainern aber auch dem Verein. Der Teamarzt bei einem Eishockey-Verein kann ein Fachspezialist oder auch Allgemeinmediziner sein. Auf alle Fälle ist er der „Gesundheitscoach“ und bedient sich seiner Spezialisten. Eine tiefe Vertrauensbasis zu den Spielern muss vorhanden sein, um auch Einblicke in ihr privates Leben, Ängste und Sorgen zu bekommen. Denn eine gute Leistung kann nur abgerufen werden, wenn auch abseits vom Sportleben alles stimmt. Als Teamarzt steht man jedoch auch häufig im Spannungsfeld zwischen den Interessen des Spielers und des Vereins – und da ist Geschick gefragt, um nicht das Vertrauen einer Seite zu verlieren.

Zusammenfassung

Eishockey ist ein faszinierender Sport mit einem Verletzungsrisiko, das kleiner ist als beim Fußball oder American Football. Da sehr hohe Kräfte wirken, ist ein ausgezeichneter körperlicher Trainingszustand und konsequentes Tragen von funktionstüchtiger Ausrüstung notwendig, um Verletzungen zu vermeiden. Striktes Einhalten von Spielregeln ist ein Muss, um die Akteure in der „Hitze des Gefechts“ zu schützen. Diesbezüglich sind insbesondere das Regelwerk und die Schiedsrichter gefordert.

Tabelle: Rehabilitationsprotokoll nach SCAT 2

  1. Absolutes Sport- und Reizüberflutungsverbot, Ruhephase
  2. leichtes aerobes Training, „Regeneration“
  3. Intervalltraining mit sportspezifischem Ansatz (Technik und Kraft)
  4. Mannschaftstraining ohne Körperkontakt
  5. Normales Mannschaftstraining
  6. Einsatzfähigkeit

Über den Autor:
OA. Dr. Gerhard Oberthaler, Facharzt für Unfallchirurgie und Sportarzt in Salzburg, Teamarzt EC Red Bull Salzburg, GOTS-Vizepräsident Österreich, www.oberthaler.info
Im Anhang finden Sie Fotos des Autors zum Thema.

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