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Wärmetherapie im Sport zur Prävention und Rehabilitation

Wärmetherapie im Sport zur Prävention und Rehabilitation

Sehr geehrte Damen und Herren,

Wärme kann ein probates Mittel bei der Therapie von Sportverletzungen sein. Was vor wenigen Jahren nur stationär in der Physiotherapie durchführbar war, ist heute durch neuere technische Entwicklungen fast überall und jederzeit möglich. Für den Sport ist die nicht-stationäre Wärmebehandlung sowohl bei Rückenschmerzen als auch bei Muskelverletzungen und Arthrose von großem Interesse. Im GOTS-Newsletter erklärt Prof. Dr. Jürgen Freiwald die Vorzüge der Wärmetherapie in der Prävention und der Rehabilitation und beschreibt die Erfahrungen aus der Praxis.

Mit freundlichen Grüßen
Andreas Bellinger, presse@gots.org

Wärmetherapie im Sport zur Prävention und Rehabilitation

Die Behandlung mit Wärme hat eine lange Tradition. Schon im alten Griechenland und Rom wurden therapeutische Wärmeanwendungen in Form von Saunen und Thermalbädern beschrieben – oder durch das Auflegen von heißen Steinen, die in Tücher gewickelt wurden. Wärme im Sport wird zur Therapie von schmerzenden Gelenken oder Körperregionen, zur Steigerung des Stoffwechsels und zur Unterstützung der Heilungsvorgänge verwendet. Bis vor wenigen Jahren war die Wärmetherapie nur stationär in der Physiotherapie durchführbar – durch neuere technische Entwicklungen hat sich dies in den letzten Jahren verändert.

Umschläge, die durch eine chemische Reaktion für mehrere Stunden eine milde Wärme (≤ 40 Grad Celsius) erzeugen, werden insbesondere bei Rückenschmerzen angewendet. Da ein beträchtlicher Teil der Sportler über Rückenschmerzen klagt, und Wärme sowohl bei Rückenschmerzen als auch bei Muskelverletzungen und Arthrose sinnvoll sein kann, sind bei gegebener Indikation nicht-stationäre Wärmebehandlungen (Wärmeumschläge) auch für den Sportler von großem Interesse.

Ziele und Indikationen der Wärmetherapie:

Bei Sportverletzungen wird die Erstbehandlung nach wie vor mit Kälte nach dem Rest-Compression-Elevation-Schema (RICE) durchgeführt. Schon nach kurzer Zeit und in Abhängigkeit von der jeweiligen Indikation wird die Behandlung mit Wärme fortgesetzt. Durch Wärmeanwendungen werden folgende Wirkungen angestrebt (siehe 1, 2):

Anwendungsformen der Wärmetherapie:

Grundsätzlich gibt es drei Typen der Wärmeübertragung (Konduktion, Konvektion und Radiation); darüber hinaus wird unterschieden in trockene und feuchte Wärmeübertragung.

Bei der Wahl des Verfahrens ist es von Bedeutung, wo und in welcher Tiefe die Schädigung liegt, und wie tief die Wärme in das Gewebe eindringen soll. Es muss festgelegt werden, wie die thermische Leitfähigkeit des Wärmeträgers ist. Zum Beispiel verfügt feuchte Wärme über eine höhere Wärmeleitfähigkeit als trockene. Ferner müssen festgelegt werden, wie hoch die Temperatur sein soll sowie die Größe der zu erwärmenden Fläche und die Dauer der Einwirkung.

“Wärmende Salben” sowie “Wärmepflaster” bewirken zwar das Gefühl der Erwärmung, die chemischen Substanzen führen jedoch zu keiner bedeutsamen Erwärmung der Haut, des Bindegewebes oder der Muskulatur und werden daher nicht als Wärmeanwendung klassifiziert (3, 4).

Oberflächliche Erwärmung mit 1-3 cm Eindringtiefe kann sowohl mit trockener als auch mit feuchter Wärmeanwendung erreicht werden.

Zur trockenen Wärmeanwendung zählen Wärmeumschläge, Fango & Gelpackungen (im Ofen oder der Mikrowelle erwärmt), Körnerkissen (im Ofen oder der Mikrowelle erwärmt), Paraffin Wachs (im Ofen oder der Mikrowelle erwärmt), oberflächige elektrische Anwendungen sowie die Saunaanwendung.

Zur feuchten Wärmeanwendung zählt die Erwärmung durch Whirlpool & Bädertherapie, heiße Wickel (im Ofen oder der Mikrowelle erwärmt) oder das Dampfbad.

Tiefe Erwärmung mit 1-5 cm Eindringtiefe kann durch Ultraschall, kurzwellige Diathermie (Elektrotherapie), Infrarot und Wärmeauflagen über längere Zeiträume (milde Wärme über Minuten bis Stunden) erreicht werden.

Wirkungen der Wärmetherapie:

Durch moderne technische Verfahren wie z.B. mit Thermokameras, Infrarotthermometer, Near Infrarot Spektrografie, Laser Speckle Imager, Myotonie, spezielle Ultraschallverfahren oder Elektromyografie können Wirkungen von Wärmeanwendungen nachgewiesen werden. Dazu gehören u.a.:

Die Erhöhung der Gewebetemperatur geht mit einer ca. zwei- bis dreifachen Steigerung des lokalen Stoffwechsels einher. Durch die verstärkte Durchblutung werden verstärkt Stoffwechselzwischen- und Endprodukte abtransportiert und die zur Heilung benötigten Stoffe wie Sauerstoff und Nährstoffe an den Ort der Heilungsvorgänge transportiert. Die entzündlichen Prozesse im heilenden Gewebe gehen zurück; der pH-Wert normalisiert sich. Die Muskulatur wird entspannt, Reflexaktivität und Verkrampfung sind reduziert und die Dehnfähigkeit der Gewebe nimmt zu; bei Rückenschmerzen konnte gezeigt werden, dass im Vergleich zur oralen Schmerztherapie (Schmerztabletten) die Wärmetherapie schneller wirkt (5).

Wärmetherapie ist bei korrekter Anwendung fast nebenwirkungsfrei, sie sollte nicht bei Wunden angewendet werden, da eine erhöhte Infektionsgefahr besteht. Auch bei akut-entzündlichen Prozessen wie z.B. entzündlichem Rheuma und bei akuten Erkrankungen, die mit einer körpereigenen Wärmeentwicklung einhergehen, sollte Wärme – wenn überhaupt – nur zurückhaltend eingesetzt werden (lokale Entzündungen, Rötung, Überwärmung, Fieber).

Erfahrungen aus der Praxis – Wärmetherapie:

In der Praxis des Hochleistungssports haben wir mit der Anwendung therapeutischer Wärme positive Erfahrungen gemacht, zumal Wärmetherapie leicht zugänglich,  kostengünstig und die Wirksamkeit durch wissenschaftliche Studien unterlegt ist (“Evidence Based Medicine”).

In den letzten Jahren wurden Wärmeumschläge entwickelt, die für ca. 8 Stunden eine trockene, therapeutisch wirksame Wärmeabgabe leisten. Sie können vom Sportler selbst angelegt werden und bieten neuartige Möglichkeiten:

Unübliche, aber sinnvolle Möglichkeiten bietet die Nutzung von Wärmeumschlägen auch im Mannschaftssport für Ersatzspieler, um Füße, Hände oder andere Körperregionen in der kalten Jahreszeit warm zu halten. In Zukunft sollte überprüft werden, ob Wärme auch eine präventive Wirkung hat – z.B. gegenüber Schmerzen oder Muskelverletzungen.

 

Literatur:

  1. Rennie, S. and S.L. Michlovitz, Therapeutic heat, in Modalities for Therapeutic Intervention, S.L. Michlovitz, J.W. Bellew, and T.P. Nolan Jr., Editors. 2012, F.A. Davis Company: Philadelphia.
  1. Freiwald, J., Rehabilitation after athletic injuries, in Sports Orthopedics. Official Manual of GOTS, M. Engelhard and A. Dorr, Editors. 2011, Neunplus1: Edition Medizin: Berlin. p. 687-709.
  1. Petrofsky, J., et al., Vergleich von Wärmeumschlägen, Creme und Pflaster zur Beurteilung der Erwärmung der Gewebe, in Deutscher Schmerzkongress. 2009: Berlin.
  1. Warnecke, J., et al., Evaluation of haemoglobin changes of skin and muscle tissue of the calf induced by topical application of a nonivamide / nicoboxil cream. Clinical and Biomedical Spectroscopy and Imaging, 2011.
  1. McCarberg, B.H., Acute back pain: benefits and risks of current treatments. Curr Med Res Opin, 2010. 26(1): p. 179-90.

Über den Autor:

Prof. Dr. Jürgen Freiwald ist Leiter des  Arbeitsbereichs Bewegungs- und Trainingswissenschaft am Institut für Sportwissenschaft der Bergischen Universität Wuppertal. In der Fußball-Bundesliga war der Sportwissenschaftler unter anderem bei Hannover 96 und Schalke 04 als Koordinator für Leistungsdiagnostik, Konditionstraining, Prävention und Rehabilitation tätig. In der Prävention und Rehabilitation von Sportlern ist er ausgewiesener Experte, was durch vielfältige nationale und internationale Publikationen im Themenbereich unterlegt ist.

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