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Verletzungen beim Turnen | 27. GOTS-Jahreskongress

Verletzungen beim Turnen | 27. GOTS-Jahreskongress

GOTS – Pressenewsletter 27.04.2012

Sehr geehrte Damen und Herren,

das Turnen ist traditionell eine zentrale Sportart bei Olympischen Spielen. Vor den Wettbewerben in London geht es im Mai bei den Europameisterschaften in Frankreich um eine internationale Standortbestimmung. Wir betrachten das Turnen in diesem Newsletter aus der Sicht der Sportmedizin. Zudem finden Sie weitere Informationen zum 27. Jahreskongress der GOTS am 22. und 23. Juni in Salzburg.

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

27. GOTS-Jahreskongress: 22.-23. Juni 2012, Salzburg Congress, Österreich

Die Jahrestagung 2012 der Gesellschaft für Orthopädisch-Traumatologische Sportmedizin (GOTS) findet erstmals in Salzburg statt. Das zentrale Thema dieses 27. GOTS-Kongresses wird der Extremsport sein.

„Die Grenze zwischen Wahn und Sinn scheint dabei zu verschwimmen“, sagt Kongresspräsident Dr. med. univ. Gerhard Oberthaler. „Erstmalig möchten wir dieses Thema im Rahmen eines Kongresses aufgreifen und einen Einblick geben in die treibenden Kräfte der Extremsportler, in ihre Motivation und in ihre professionelle Vorbereitung.“ Neben den Vorträgen zu den Themen der Extremsportmedizin stehen die Gebiete der Meniskuschirurgie, der Implantate und Biomaterialien in der Sportmedizin und der Lebensbewältigung nach einem Sporttrauma auf dem Kongressprogramm. In Satellitensymposien, Instruktionskursen und Workshops geht es um die Wettkampfmedizin, Protektoren im Sport, Techniken in der Physiotherapie, Biomechanik und biotechnologische Konzepte in der Sportmedizin. Auch der Welt-Skiverband FIS hält im Rahmen des Kongresses ein Symposium ab.

Weitere Informationen: www.gots-kongress.org

Pressetext: Geräteturnen aus sportmedizinischer Sicht

Vom 21. bis 27. Mai 2012 finden in Montpellier/Frankreich die Turn-Europameisterschaften der Männer statt. Turnusgemäß werden in diesem Jahr keine Mannschaftsentscheidungen durchgeführt, sondern Einzelmehrkämpfe und Wettkämpfe an den einzelnen Geräten (Boden, Pauschenpferd, Ringe, Sprung, Barren und Reck). Die diesjährigen Europameisterschaften haben eine besondere Brisanz, da es im Vorfeld der Olympischen Spiele auch um eine internationale Positionierung geht. Die amtierenden Europameister Philipp Boy aus Cottbus (Mehrkampf) und Marcel Nguyen aus Stuttgart (Barren) wollen versuchen, ihre Vorjahreserfolge zu wiederholen und um die Medaillenvergabe mitkämpfen.

Gerätturnen ist eine technisch-kompositorische Sportart und stellt hohe Anforderungen hinsichtlich motorischer Grundeigenschaften (Kraft, Kraftausdauer, Beweglichkeit), psychomotorischer Grundleistungen (motorische Lernfähigkeit, Bewegungsgedächtnis, Bewegungspräzision, Bewegungsadaptation, psychodynamische Fähigkeit, Kognition), Koordination und Konzentration. Aufgrund der vielseitigen und allumfassenden sportlichen Ausbildung zählt Gerätturnen damit sicher mit zu den vollkommensten Sportarten, unterliegt jedoch auch besonderen sportartspezifischen Belastungen und Beanspruchungen des Stütz- und Bewegungsapparates (siehe Infokasten 1).

Sprunggelenksverletzungen am häufigsten
Eine eigene Auswertung von 1988 bis 1996 umfasst 258 akute Verletzungen (siehe Bild 1), 600 Überlastungsschäden (siehe Bild 2) und 217 Knorpelverknöcherungsstörungen bei Kindern und Jugendlichen (siehe Bild 3). Neuere und umfangreiche Daten liegen zwar aus den Jahren 1997 bis 2010 vor, wurden jedoch bisher nur zu einem kleinen Teil ausgewertet. Hinsichtlich der Verteilung, Art und Schwere der Verletzungen, Überlastungsschäden sowie der Knorpelverknöcherungsstörungen gibt es jedoch keine wesentlichen Veränderungen.

Bei den Verletzungen sind Sprunggelenksverletzungen mit 34,5 Prozent am häufigsten. In erster Linie handelt es sich um Kapsel-Band-Verletzungen, die meistens am Boden und bei Landungen vom Gerät durch Umknicken über Mattenkanten oder bei Absprüngen entstehen. Ein nicht unerheblicher Teil resultierte in der jüngsten Vergangenheit aber auch durch Fußballspielen (Warm-up-Phase)!

Frakturen, Kapselverletzungen & Co.
Die übrigen akuten Verletzungen verteilen sich in etwa zu gleichen Teilen auf die weiteren Körperregionen. Kreuzbandrupturen am Kniegelenk mit und ohne Meniskusverletzungen entstehen meist nach Sprüngen oder Landungen vom Gerät infolge unvollständiger Längenachsendrehung oder als Hyperextensionstrauma, wenn Landungen durch unvollständige Breitenachsendrehung bei Vorwärtssprüngen mit gestreckten Kniegelenken zuerst über die Ferse erfolgen und muskulär nicht kompensiert werden können.
An den Handgelenken verursachen Kehrschwünge im Stütz am Pauschenpferd Diskusläsionen, wenn es zu einer Überdrehung nach ulnar oder Abrutschen von den Pauschen kommt, wobei gleichzeitig hohe Torsionskräfte auf das Gelenk einwirken.
Gelenknahe Unterarmfrakturen, so genannte „Grip Lock Injuries“ sowie Kapselbandverletzungen der Handwurzelgelenke sind typische Verletzungen am Reck durch Hängenbleiben mit den Reckriemchen – kommen aber insgesamt sehr selten vor. Frakturen und Luxationen des Ellenbogens entstehen ursächlich fast ausschließlich durch Stürze am oder vom Gerät als Hyperextensionstrauma kombiniert mit Varus- oder Valgusstress. Am Barren kommen typischerweise Abrissfrakturen des Processus coronoideus bei Stürzen auf die im Ellenbogen gebeugten Oberarme vor. Fingergelenksverletzungen entstehen meist durch Vergreifen im Stütz an Pauschenpferd und Barren und kommen häufig vor.
Verletzungen der Schultern entstehen ebenso meist durch Stürze vom Reck nach misslungenen Flugelementen. Schwere Wirbelsäulenverletzungen kommen selten vor. Jedoch können Hyperflexions- oder Hyperextensionstraumata bei Sturz auf den Kopf oder Nacken Verletzungen der unteren HWS-Segmente bis hin zu Querschnittsverletzungen verursachen.

Belastete Sprunggelenke
Überlastungsbeschwerden entstehen infolge chronischer Über- oder Fehlbelastung mit daraus resultierenden rezidivierenden Mikrotraumata. Das Hyperextensions-Pronations-Trauma bei unvollständiger Breitenachsendrehung mit Landung in Vorlage (Gegenstellen der Füße) ist einer der am häufigsten vorkommenden Schädigungsmechanismen im Gerätturnen mit unterschiedlichen Auswirkungen auf Knorpel und Knochen: Kontusion, Bone Bruise, Knorpelflakes bis hin zu Osteochondrosis dissecans, insbesondere bei repetitiven Ereignissen. Meniskusverletzungen am Kniegelenk werden verursacht durch Vorwärtssprünge mit 2 ½ -Längenachsendrehungen am Boden.

Gefährdete Sehnen
Am Schultergelenk sind Hypermobilitäten/Instabilitäten meist nach anterior und/oder inferior sowie Impingements mit in der Folge sehr häufig auftretenden Tendinitiden, aber auch gehäuft Teilrupturen der Supraspinatussehne und Rupturen der langen Bizepssehne sowie SLAP-Läsionen vorherrschend. Auffallend häufig und turntypisch treten Teilkapselsprengungen des AC-Gelenks auf, die maximal einem Typ Rockwood II oder Tossy I–II entsprechen. Ursache sind besondere Beanspruchungen des Gelenks in einer funktionell-anatomisch und biomechanisch sehr ungünstigen Gelenkstellung mit teilweise extremem Spannungsverhalten der Ligamente des AC-Gelenks, aber auch der glenohumeralen Bänder, insbesondere beim Ringeturnen.

Überlastungsprobleme an den Ellenbogengelenken treten oft als Epicondylitis radialis et ulnaris oder selten in Form von Knorpelschäden oder Osteochondrosis dissecans des Capitulum humeri auf. Dabei entstehen die größten Beanspruchungen beim Kreuzhang und anderen statisch-dynamischen Kraftelementen über meist hyperextendierte Ellenbogengelenke an den Ringen.

Selten Wirbelsäulenverletzungen
Hohe Stützbelastungen am Pauschenpferd (vor allem im Flachstütz) in Kombination mit Rotations- und Scherkräften führen häufig zu Knorpelbelastungen unterschiedlicher Schwere. Eine typische Belastungsfolge ist die Tendovaginitis flexor carpi ulnaris sowie degenerative Veränderungen des Discus bis hin zu Discusrissen.

Im Bereich der Wirbelsäule treten Beschwerden im Lumbalbereich infolge Discusprotrusion/-prolaps und Spondylolysen/-listhesen auf. Die Inzidenz liegt mit 7,6 Prozent (eigene Untersuchung) nur minimal über der Inzidenz in der Normalbevölkerung.
Bei jugendlichen Turnern sind überwiegend Knorpelverknöcherungsstörungen zu finden mit Schwerpunkt im Bereich der Gelenke der oberen Extremität. An der Wirbelsäule handelt es sich in erster Linie um Veränderungen an den ventralen Randleistenkernen der unteren Thorakal- und oberen Lumbalsegmente, wobei eine oder meistens mehrere Wirbelkörper betroffen sind.

Rolle des betreuenden Arztes
Im Vordergrund der medizinischen Betreuung von Turnern steht die adäquate Behandlung von Verletzungen, insbesondere unter Beachtung der Anti-Doping-Bestimmungen.
Um eine optimale Betreuung zu gewährleisten, sollte der Mannschaftsarzt möglichst regelmäßig in Training und Wettkampf vor Ort sein. Umfassende Kenntnisse der Sportart und deren Belastungsprofile wären wünschenswert. Darüber hinaus hat der Mannschaftsarzt jedoch noch weitere wichtige Funktionen: Er ist Vertrauensperson für die Athleten und Mittler zwischen Athlet, Trainer und Funktionär. Er sollte sich zudem um Planung, Durchführung und Einhaltung von Präventions- und Rehabilitationsmaßnahmen kümmern. Eine ständige Kommunikation und Zusammenarbeit zwischen Arzt, Physiotherapeut und Trainer ist unabdingbare Vorraussetzung für eine optimale Betreuung.

Bild 1: Häufigkeit akuter Verletzungen

Haeufigkeit_akuter_Verletzungen

Bild 2: Häufigkeit chronischer Verletzungen

2

Bild 3: Verteilung Knorpelverknöcherungsstörungen

Verteilung_Knorpelverknoecherungsstoerungen

Infokasten 1: Sportartspezifische Belastungen und Beanspruchungen

Infokasten 2: Prävention

  1. Gerätetechnik
    • belastungsreduzierende, elastisch federnde Konstruktionen der Turnböden
    • Schaumstoffgruben, die das Erlernen von schwierigen Flugteilen, Sprüngen und Abgängen risikoarm erlauben
    • doppelelastische Sprungbretter und Niedersprungmatten mit hohen Dämpfungseigenschaften zum Schutz der Gelenke der unteren Extremitäten
    • Handschutzleder mit eingearbeiteten Röllchen schützen die Haut und verbessern den Griff an Ringen, Reck und Stufenbarren („Hakeneffekt“)
    • diverse Hilfsgeräte für ein methodisches Erlernen von Übungsteilen
    • Weiterentwicklung und Verbesserung bestehender Techniken zur Bewegungsausführung und Reduktion von Risiko und Belastung
  2. Schaffung körperlicher Vorrausetzungen
    • Schulung von Kraft und Kraftausdauer
    • Erlernen einer hohen Spreizfähigkeit und guter Bewegungstechnik
    • Erlernen von Bewegungssteuerung in Raum und Zeit
    • Entwicklung des Gleichgewichtsgefühls
    • Steuerung der Muskelspannung
  3. allgemeine Prävention
    • orthopädische und internistische Eingangsuntersuchungen zu Beginn des Leistungssports und jährliche Kontrollen
    • körperliche, technische, koordinative und spezielle Bewegungsausbildung
    • Mitarbeit von in der Sportart qualifiziertem Personal (Trainer, Physiotherapeuten, Ärzte)
    • Ganzkörpergymnastik, Umsetzen der Präventivprogramme
    • Belastungsreduktion in sensiblen puberalen Phasen
    • langsamer Belastungsaufbau nach Verletzungen oder Trainingspausen
    • ausreichende Aufwärmphasen zu Beginn des Trainings und Cooldown am Ende des Trainings
    • rechtzeitiges Einlegen von Trainingspausen bei Ermüdung und/oder Überlastung
    • Vorsorge (einwandfreie Trainings- und Wettkampfausrüstung) und Nachsorge (Massagen, Sauna, heiße Bäder)
    • Behandlung von Bagatellverletzungen sofort und gezielt
    • ausreichende Kompensations- und Regenerationsphasen
    • ausgewogene, bedarfsgerechte Ernährung

Der Autor:
Dr. med. Hans-Peter Boschert, Arzt für Allgemein- und Sportmedizin, Mitglied in der Praxisgemeinschaft „Die Sportorthopäden an den Heilquellen“ in selbständiger Praxis in Freiburg, seit 1990 Fachgebietsarzt Turnen Männer im Deutschen Turnerbund, als betreuender Arzt Mitglied der Olympiamannschaft in Sydney 2000, Athen 2004 und Peking 2008

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