Überlastungsbedingte Verletzungen von Sehnen sind typische Beschwerden von Sportlern jeden Alters und Leistungsanspruchs. Gerade die lasttragenden unteren Extremitäten, besonders die Achilles- und die Patellarsehne, sind bei vielen Aktivitäten und Sportarten für Tendinopathien anfällig. Doch was tun, wenn die Sehne durch Überlastung verletzt ist?
Von Tendinopathien spricht man, wenn eine schmerzhafte und in ihrer Funktion eingeschränkte Sehnenstruktur vorliegt. Sportler haben dabei erhebliche Einbußen ihrer Leistungsfähigkeit mit der potenziellen Gefahr eines Sehnenrisses. Gründe für Tendinopathien können eine eingeschränkte Stoffwechselaktivität des Sehnengewebes mit veränderter Kollagenzusammensetzung mit feinsten Rissen auf mikrostruktureller Ebene sein. Oder auch Entzündungsprozesse, die mit der Synthese und Interaktion proinflammatorischer Substanzen einhergehen.
Detaillierte Kenntnisse über die den Sehnenstoffwechsel beeinflussende Belastungsformen sind für Ärzte, Therapeuten und den Sportler deshalb unerlässlich.
Bekannte Trainingsparameter für Sportler sind die Intensität (Höhe und Richtung der mechanischen Belastungen), Umfang (Dauer der mechanischen Belastungen), Frequenz (Häufigkeit der mechanischen Belastung je Zeiteinheit), Regenerationszeiten sowie die Geschwindigkeit des mechanischen Kraftanstieges (Kraftanstiegsrate und Kraftimpuls).
Aus biomechanischer Sicht hat die Richtung der Krafteinwirkungen entscheidende Bedeutung. Axiale Traktionsbelastungen (Zugbelastung) sind physiologischer mechanischer Natur für kraftübertragende Sehnen und daher ideal, um optimale, der Zugrichtung entsprechende Umbau- und Anpassungsprozesse auszulösen.
Verschiedene Therapien möglich
Die jeweilige Therapie muss immer individuell auf den Patienten zugeschnitten sein. Eckpfeiler sind
die Aufklärung des Patienten und die realistische Einschätzung der individuellen zeitlichen Ressourcen. Ein Trainingstagebuch mit der Vorgabe und Dokumentation von Therapie- und Trainingsmaßnahmen sowie der Veränderungen des Schmerzempfindens (z. B. visuelle Analogscala) ist sinnvoll.
Priv.-Doz. Dr. med. Thilo Hotfiel, Orthopäde, Unfallchirurg und Vorstand in der GOTS erklärt: „Das ´exzentrische Training´ hat sich in einer Vielzahl hochqualitativer Studien als therapeutischer Goldstandard in der konservativen Behandlung der Achilles und Patellarsehnen-Tendinopathie etabliert. Für Anpassungen des Sehnengewebes ist allerdings die Höhe der einwirkenden Kräfte, die Geschwindigkeit und Qualität der Bewegungsausführung sowie deren Dauer bedeutsamer als die Kontraktionsform der mechanischen Spannung erzeugenden Muskulatur. Neben dem exzentrischen Krafttraining zeigen deshalb ebenso das isometrische, konzentrische und (Heavy) Slow Resistance Training gute klinische Ergebnisse.“
Die verschiedenen Trainingsformen sind in Abhängigkeit des Stadiums, der Lokalisation, der Belastungsfähigkeit und des Schmerzniveaus durchzuführen. Mit abnehmenden Beschwerden gilt es nach einer ersten Phase langsamer und besonders kontrollierten Übungen die Belastungen zu steigern und sowohl verstärkt schnellkräftige als auch sportspezifische Bewegungsmuster in das Trainingsprogramm zu integrieren.
Auch die extrakorporale Stoßwellentherapie (ESTW) zeigt bei einigen Tendinopathien positive Effekte. Bei Mid-Portion-Tendinopathien ist häufig eine Kombination von ESTW und exzentrischem Krafttraining wirksam.
Auf die peri- und peritendinöse Injektion von Glucocorticoiden (Cortisonpräparate) sollte bei Tendinopathien verzichtet werden.
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