German Marquez flexed his right arm as he pointed to the small zipper scar near his elbow.
“I have a brand new arm,” Marquez said. “I’m ready for 10 more years.”
It’s all systems go for the Rockies’ 2021 All-Star pitcher who underwent Tommy John surgery last May. What seemed like a crushing blow for Marquez at the time now looks like a bump in the road. At least, that’s how Marquez sees it.
He’s on track to return to the rotation after the All-Star break and has begun throwing bullpen sessions during spring training, although he’s currently limited to a fastball-only program.
Who knows? Might Marquez, who turned 29 on Feb. 22, still be pitching as he nears 40?
“My arm has never felt this good,” Marquez said with a smile. “My elbow feels good and my shoulder is stronger from all the rehab work.”
Such is the miracle of modern sports medicine and Tommy John surgery, which made its debut 50 years ago. According to a study by the Cleveland Clinic, professional baseball players have a return-to-play rate of 80% to 95%, depending on age, the level they pitch and their rehabilitation regimen.
“Some guys come back even stronger because of all of the work they have done during their rehab,” Rockies manager Bud Black said. “That’s the thing that I have noticed over the last three or four decades.”
Dr. Frank Jobe, who saved the career of Dodgers pitcher Tommy John, certainly never envisioned the success rate that first elbow surgery would eventually lead to. In that landmark procedure in September 1974, Jobe took a tendon from John’s wrist, drilled holes into John’s ulna and humerus bones and grafted the tendon in a basic figure-eight design, held in place by anchors. Jobe famously gave the procedure about a 1 in 100 chance of working at the time.
But before baseball gets too ho-hum about the magical elbow fix, it should be remembered that there are still major downsides to blowing out an elbow. First of all, a full recovery usually takes about 18 months. That’s a major chunk of time for any professional pitcher, but especially young pitchers who can see their careers derailed by an elbow injury and never get back on track.
And although the success rate is high for major leaguers who undergo Tommy John, there are no guarantees. Moreover, as Jeff Passan pointed out in his 2016 New York Times best-seller, “The Arm: Inside the Billion-Dollar Mystery of Baseball’s Most Valuable Commodity,” Major League Baseball invests, and loses, a lot of money on pitchers. As Passan wrote, major league teams spend more than $1.5 billion annually on pitchers’ salaries, more than five times the combined cost of every starting quarterback in the NFL. And pitchers’ salaries have continued to soar since Passan wrote his book.
According to a 2023 story by Sports Illustrated senior baseball writer Tom Verducci, big-league teams paid $486 million in 2022 to 427 pitchers on the injured list.
“Any time you have surgery there is a downside because there is always a risk and it disrupts careers,” longtime Rockies trainer Keith Dugger said. “Most of the guys who you hear about who have Tommy John are the elite of the elite at this level. You don’t hear as much about the guys who never make it back.”
Rockies right-hander Peter Lambert, a second-round draft choice out of high school in 2015, underwent Tommy John in July 2022. After a bumpy comeback that took the better part of two years, he says his elbow now feels fine. He’s now competing for a spot in the rotation, but admits it’s a tough road to travel.
“Speaking for myself, I was never worried that I would never pitch again, just knowing how common and successful the surgery is,” Lambert said. “Speaking for myself, and talking to other guys who have had the surgery, you are confident that you are going to come back.
“The big blow is that you’re gone for 12, 16, 18 months. Heading into the surgery, you’re like, ‘Dang, I don’t get to pitch for 16 months.’ That’s what the big blow is. Plus, it’s a long, tedious recovery.”
The “Tommy John epidemic,” as it came to be known a decade ago when studies documented the alarming rise of elbow injuries, particularly among high school pitchers, is not the hot-button issue it used to be. Teams have got the rehabilitation process down to a science where every step of recovery is mapped out.
But that doesn’t mean the elbow problem has gone away. The quest for 100 mph fastballs continues to lead to career-altering injuries.
Last year, 29 major league pitchers underwent TJ surgery, according to statistical analyst Joe Roegele’s database. In 2015, 24 big-league pitchers had the procedure. So the numbers remain about the same.
Last year’s TJ list includes a who’s who of elite pitchers: Orioles closer Felix Bautista, Dodgers starters Dustin May and Tony Gonsolin, new Dodgers wunderkind Shohei Ohtani and Rangers flamethrower Jacob deGrom. Both Ohtani and deGrom have had Tommy John twice.
The Rockies had three big leaguers undergo elbow surgery last season — right-handed starter Antonito Senzatela, lefty reliever Lucas Gilbreath and Marquez. Top pitching prospects Gabriel Hughes, Jordy Vargas and Jackson Cox also had Tommy John. But last year was an anomaly for the Rockies’ organization, which has had the third-fewest Tommy John surgeries in the majors since 2010.
“We just had a bad spell where we had some high-profile kids get (elbow) injuries last year,” Dugger said. “I don’t like to make comparisons with other teams, because there are so many variables, but we rank near the bottom in terms of Tommy John surgeries.”
Over the last five years, the Rockies have had 11 pitchers in their organization (including newly drafted players) undergo the procedure. By comparison, the Dodgers have had 20, the Yankees 28.
But no matter the team, elbow injuries stem from pitchers chasing heat. The average fastball velocity in MLB increased from 90.5 mph in 2008 to 93.9 mph last season, according to Baseball Savant. The number of major league pitches clocked at 100 mph and faster more than tripled over three years, from 1,056 in 2019 to 3,348 last year.
Last year, according to USA Today Sports research, of the top 64 hardest throwers (based on average fastball velocity calculated by Statcast) 30 had to undergo Tommy John surgery.
Dugger also believes that pitchers, trying to impart more spin on the baseball, are gripping the ball tighter. That is also leading to elbow problems.
“Guys squeeze the crap out of the ball compared to the way they used to,” Dugger said. “That’s hard to change because guys know they can manipulate the ball with increased pressure. So it’s a fine line. Do you affect their pitch ability by trying to change it to something they’re not used to?”
While Tommy John surgery has, unquestionably, stood the test of time, chasing maximum velocity still has a downside, especially for those young players who believe they must chase 100 mph to make a mark and chase their big-league dream.
“At the time of young players’ development, those are crucial years,” Lambert said. “With the recovery time, you can be put on the back burner or forgotten about and other prospects will pass you up. It’s a tough place to be.”
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