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Masahiro Tanaka can avoid surgery and still be dominant, says Adam Wainwright

Starting pitcher Adam Wainwright of the St. Louis

Starting pitcher Adam Wainwright of the St. Louis Cardinals throws in the first inning against the Los Angeles Dodgers during Game 1 of the National League Division Series at Dodger Stadium on Oct. 3, 2014 in Los Angeles. Credit: Getty Images / Kevork Djansezian

JUPITER, Fla. - What if Masahiro Tanaka could be a 20-game winner this season, with a sub-three ERA, 200-plus innings and 30 starts?

What if Tanaka could pitch even better in the playoffs? What if the ulnar collateral ligament inside his right elbow was an afterthought?

It's all possible. Because it's happened before.

But don't take our word for it.

Listen to Adam Wainwright.

Wainwright, the Cardinals' ace, knows better than just about anyone what it's like to pitch with a small, manageable UCL tear. He's done it not once, but twice -- and dominated major league hitters for six years before ultimately needing Tommy John surgery after the 2010 season.

By then, Wainwright had pitched 182 games in the majors -- including 99 starts -- and placed both second (2010) and third (2009) in the Cy Young voting. Overall, Wainwright amassed 874 innings during that pre-op span, including 233 in 2009.

He was first diagnosed with a partial tear as a high school junior but still passed his pre-draft MRIs and didn't suffer another one until years later, when he reached Triple-A Memphis. On both occasions, the doctors advised against surgery, and Wainwright gladly went the conservative route to avoid a year on the shelf.

"They told me I had a better- than-average chance," Wainwright said Friday in the Cardinals' clubhouse at Roger Dean Stadium. "I did have a partial tear that was a little more extensive than the first one, but I had at least a 60 percent chance to come back as strong as I was before without the surgery -- and I did.

"I came back throwing as hard or harder than I was before, just like I did the time before that. You just put so much work into your shoulders and forearms and the muscles that maintain the strength to keep your elbow safe and healthy that you're bound to be a little more polished when you're done. I healed up perfectly fine and I had six years before I blew it out completely."

Tanaka found himself in a similar spot last July, when discomfort in his elbow required an MRI that revealed what has been described as a very small tear. Without knowing the exact measure, it's impossible to say that he and Wainwright are identical cases. But Tanaka was told by numerous orthopedists that he could continue to pitch without Tommy John surgery -- just as Wainwright was on two separate occasions.

Wainwright said the tear in high school was very minor -- "almost like a stretching of the ligament more than anything," he said. But after scar tissue pretty much covered up the first tiny rip, it gave way again at Triple-A in the same spot.

"They were a little more worried about it then," Wainwright said, "but felt I was OK to try to rehab it for six weeks or so."

He did. The doctors also told Wainwright that he would know early in the process if it wasn't going to work. And if the pain soon made it impossible to pitch, he would need the surgery.

But Wainwright responded very well to the rehab and returned to the Arizona Fall League, where he began pitching again as if nothing was wrong with his elbow.

"I felt great," Wainwright said. "I was throwing hard again, curving it, sinking it and doing all that stuff. Then they sent me home and just said to take some time off."

Tanaka took the same route last season but followed an even more cautious rehab program that kept him sidelined for 10 weeks and included a regimen of platelet-rich plasma injections to promote healing in the elbow. Tanaka returned to make two more September starts but was on a short leash. He pitched a total of seven innings, allowing 12 hits with two walks and six strikeouts.

After more rehab during the offseason in Japan, Tanaka has looked sharp in spring training. He has a 1.74 ERA in three starts, giving up six hits and a walk in 101/3 innings and striking out 12.

His progress would suggest that the elbow is in great shape, even though the possibility of another tear always looms.

Joe Girardi announced Friday that Tanaka will be the Opening Day starter, but the Yankees will monitor his workload closely.

How long can Tanaka's elbow hold together? It's hard to say. Many pitchers probably don't even realize they have a small UCL tear until it grows big enough to get their attention. In Wainwright's case, he said scar tissue patched up the tears each time. That didn't last forever, but he still got six great years.

"It just finally went," Wainwright said. "When you're chopping down a tree, eventually if you keep hitting it on the same spot, it's going to go down."

Still, Wainwright has no regrets about going with the nonsurgical option. He felt even better about it once he did have to go through the whole Tommy John ordeal.

"What I always tell people is, if you have a great chance to come back successfully, then you should not have the surgery," Wainwright said. "People and parents don't really understand the Tommy John procedure and how hard the rehab is. Even though they have great numbers to verify why you should have it, there's still a percentage of people that don't come back healthy."

Wainwright said he's often approached by parents asking if their son should have Tommy John -- almost as if it's an elective surgery -- with the thought being that he'll return with increased velocity.

Wainwright usually responds, "Well, does he have a blown-out ligament?"

If not, he recommends building up strength instead -- in the shoulders, forearms and hands -- to guard against injuries.

As for the surgery, Wainwright sees it as strictly a last resort, when all else has failed. It's just too much of a grind getting back.

"Each case is different," he said. "I just know that it's a year of rehab, basically, that you should try to avoid because it [stinks].''

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