Professor Ye Wenling, former chairman of the Taiwan Society of Sports Medicine
The 2026 World Cup has always been seen as the last tournament for the previous generation of football gods. Especially Cristiano Ronaldo and Messi, followed by Neymar. Under the brilliance of the new generation's war god Mbappé, and with the emergence of many young war gods like Yamal, Saka, Endrick, Estevão, etc., whether the old war gods, burdened by injuries, can have one last glorious moment has always been the focus of this World Cup.
Compared to Neymar's ups and downs, Cristiano Ronaldo and Messi have always been the focus of creating surprises. Especially Messi, who single-handedly revitalized Major League Soccer. However, the defending champions, Argentina, have received heartbreaking news: Messi is suffering from a severe hamstring muscle strain, and his participation in this World Cup is in doubt. Is the twilight of the gods truly upon us?
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Generally, middle-aged professional football players are defined as those aged 30 to 35 and above. This differs from amateur athletes, and middle age here aligns with the general public's definition of middle age. The hamstring muscle group is the most frequently injured, accounting for about 4% to 13% of all football injuries. This is especially true for the biceps femoris and rectus femoris. Most injuries occur at the junction of the muscle and tendon, or the tendon and bone. The main reasons are decreased muscle elasticity, fibrosis from old injuries, and slower recovery from new injuries. The result is that the injury rate for middle-aged athletes has been increasing over the past 20 years. Furthermore, 18% of these are repetitive injuries, especially in dense schedules and high-intensity interval running.
Clinically, muscle strains are divided into three grades: Grade 1 involves minor muscle fiber injury, with mild pain and little functional impact. Grade 2 shows significant muscle fiber rupture and functional impairment, usually clearly visible on ultrasound. A period of rest and treatment is necessary. Grade 3 injury involves extensive muscle fiber rupture, with obvious symptoms, visible rupture externally, significant hematoma, and marked loss of function. In such cases, rest is insufficient; medical intervention, even surgical intervention, is required. Ironically, the mechanism of muscle injury is most typically non-contact. For example, during a full sprint with a sudden turn or sudden stop, the hamstring muscles are under high-tension eccentric contraction, resulting in muscle injury. Another situation is during a forceful long pass or shot; although the muscle is undergoing normal concentric contraction, fatigue, insufficient warm-up, or muscle strength imbalance can easily lead to injury at the tendon attachment or the muscle-tendon junction. Another scenario is direct impact, which usually results in muscle contusion and hematoma. The consequence is that the muscle will subsequently experience decreased elasticity due to fibrosis.
Undoubtedly, age is the highest risk factor for middle-aged athletes. Other common problems include insufficient warm-up, excessive match frequency, inadequate sleep and nutrition, muscle strength and flexibility imbalance, and habitual imbalanced athletic techniques. These are all common risk factors. The best treatment is prevention, with sufficient dynamic warm-up and progressive dynamic stretching being most important. Systemic neuromuscular training, controlled training and match loads, and correction of faulty movements all contribute to injury prevention. Treatment primarily involves ice application, protection, compression, and ligation during the acute phase. Appropriate medication is also essential. In the mid-to-late stages, the focus is on retraining concentric and eccentric muscle strength contractions. Correction of habitual movements, in particular, requires scientific instruments for thorough correction. Injections of high-concentration platelet-rich plasma (PRP), high-concentration glucose, amniotic fluid, and other extracellular matrix (ECM) have some effect, but long-term, large-scale evidence is still lacking. Evidence for exosome and stem cell treatments is even weaker, although they may hold future promise.
We have always hoped that Messi would shine in this World Cup. A World Cup without Messi is unimaginable. We know that the twilight of the gods will eventually come, but we sincerely hope it will be after July 19th.
