Pay no attention to that aggravation behind the throwing elbow, Adam Wainwright is 'fine'

Before Tuesday's NLDS Game 4, St. Louis Cardinals manager Mike Matheny discussed who would start Game 5, if one took place, and let slip that Lance Lynn would start on regular rest if Adam Wainwright was unable to pitch. The media took Matheny's poorly articulated statement and ran with it. But even after the Cardinals attempted to walk back Matheny's words later that same day, the question lingered: Should we be worried about Wainwright?

The plot thickened on Friday with Wainwright's NLCS Game 1 press conference even though the veteran attempted to slim it down.

Brian Stull reported on Wainwright's press conference at STL Baseball Weekly. From Stull's post, Wainwright gave an overview of how the elbow works and explained what was not wrong with his at the present time:

"I get it," stated Wainwright as his elbow was questioned again. "When people hear 'elbow,' they think the worst, and, you know, rightfully so. I’ve obviously had an elbow issue before, I had that fixed. And if you see the amount of stars going down with elbow injuries these days, it’s natural to have that reaction. I understand that, so I don’t ever scoff at people that worry about elbow problems here or there.

"There’s all kinds of sides of your elbow, ligaments and tendons in there that do different things. The only thing I can do is tell people it’s not my ligament, my ulnar collateral ligament, and trust that people will believe me. If they don’t, that’s okay. I’ll go out and hopefully prove that I’m okay with my pitching."

Wainwright understands we're scared. It's natural to feel that way when the health of your ace starting pitcher's throwing arm is a topic of media coverage. But rest assured that Wainwright's ulnar collateral ligament (UCL), the one that he had Tommy John surgery to replace, is fine. With Wainwright's demeanor, accent, and smile, how can one not believe him? Wainwright could take the sprinkle doughnut off my plate, eat it in front of me, and, with sprinkles and doughnut crumbs in his goatee, tell me he didn't eat my sprinkle doughnut, and I'd believe him. (Sure, the ugly goatee makes it a little bit harder to believe him, but it can't overcome his demeanor and accent.) So Waino's UCL is fine, you guys. Trust Wainwright.

But Wainwright also shared that he had felt something similar in NLDS Game 1 to what he had experienced in Tampa on June 10, a sensation that led to an MRI (which revealed no structural damage), anti-inflammatory injection, and the team opting to give him a start off. Again from Stull's post:

"The problem that I have is being way overblown. I’ll be fine to pitch tomorrow and I’ll go out there and battle like I always do."

"Yeah, it was a factor in Game 1," admitted Wainwright, who allowed 11 hits and 6 runs in 4.1 innings of that start in the NLDS.

"Here is the positive, I can be very honest about this because I’ve been through it. When I took a game off after my Tampa start earlier this season, I aggravated my elbow, and it’s the backside of my elbow. So the elbow‑fearing world can know it’s not my ligament.

"But on the backside of my elbow I aggravated something that when I did that, it got to its worst. And after that, it goes on the mend and gets better and better progressively. The other day I reaggravated that same spot on the backside of my elbow and now I’m on the mend, and I can feel something. I’m very confident about it because I felt that before, the exact same thing. I was able to recover very well from it. I have no doubts going into tomorrow."

The revelation that Wainwright's June health issue was located behind his elbow is somewhat new. At the time, general manager John Mozeliak analogized Wainwright's condition to tennis elbow, a condition that occurs when tendons are overworked (like, for example, by the repetitive throwing of a baseball or swinging of a tennis racket). The Mayo Clinic explains:

The pain of tennis elbow occurs primarily where the tendons of your forearm muscles attach to a bony bump on the outside of your elbow. Pain can also spread into your forearm and wrist.

Behind is different from outside—at least to me—so Mozeliak likening Wainwright's condition to something similar to tennis elbow seems consistent with Waino's Friday description. The prescription to cure tennis elbow is rest. Presumably, the same course of treatment applies to a similar injury behind the elbow like Wainwright's.

Wainwright had about nine days of that in June before resuming his job: throwing a baseball over and over again. Wainwright hasn't been the same pitcher since returning to action after experiencing that singular sensation behind his elbow in Tampa. The following chart excludes Wainwright's June 10 start, when his elbow issue flared up and required an MRI and injection, and shows Wainwright's splits before and after that start as well as his overall 2014 stat line.

Adam Wainwright 2014: Before 6/10 vs. After 6/10

While Wainwirght's ERA before June 10 isn't all that different from his ERA after June 10, there's a difference in his peripherals. Specifically, a reduced K rate. Wainwright had an excellent 24.9% strikeout rate before June 10. For a point of reference, that K rate would've tied Wainwright with Jon Lester at 12th among MLB starters who qualified for the ERA title this season had he finished the year at 24.9%. After the elbow issue arose in Tampa, Wainwright struck out just 17.2% of opposing batters. That would tie Wainwright for the 59th highest K rate among qualified MLB starters (oddly enough, tied with Justin Verlander, among others).

For what it's worth, Wainwright's K rate rose each month after June. It was 12.4% in July, 16.6% in August, and 19.9% in September. None of those are as high as the 25.3% strikeout rate Wainwright posted in March/April or the 24.1% K rate of May, but the steady increase was nonetheless heartening as October approached.

Then in October's first start—NLDS Game 1 vs. L.A.—Wainwright experienced the same issue he did on June 10. Derrick Goold, the ace St. Louis Post-Dispatch beat writer, replied to a tweet expressing worry about Waino from Jesse Spector of the Sporting News as follows:

@jessespector my experience with Wainwright is he doesn't talk about such things until they're over, done.

— Derrick Goold (@dgoold) October 11, 2014

Wainwright may very well feel that the elbow issue is behind him—"over, done" in Goold's words. But we've seen that, during the grind of the regular season, Wainwright was never as effective as he was before being sidelined for a start due to the elbow issue. Wainwright's mental outlook didn't mean that his arm allows him to be as dominant a pitcher as he was before the condition flared up. Not that Wainwright would voluntarily step aside even if did. In Goold's Post-Dispatch article on Waino's elbow health, he quotes the ever-colorful A.J. Pierzynski:

"You’d have to have a tranq gun to keep him out of (it)," catcher A.J. Pierzynski said. "In Game 1, same thing. You better have a police escort to get him off the field because he’s going out there regardless of what the lineup says."

Without a doubt this is the attitude you want an ace starter to have. And it's in lockstep with what Matheny expects from his No. 1 starter, a view he most recently expressed on Tuesday regarding Wainwright, as reported by Goold:

"He’s just been grinding. There are days when you’re grinding when you just can’t get it right. He was having trouble with that in Game 1. He’s thrown a lot of innings. He’s had a lot of work. That’s what your ace does."

The question thus is: How long of a leash will Matheny give Wainwright in NLCS Game 1? Will the manager pull Wainwright if his fastball control is as horrible as it was in NLDS Game 1 but before the Cards are facing a multi-run deficit? Or will Matheny stick with his ace even if it's clear his body has betrayed him and he doesn't have that wagonmaker-quality stuff we're so accustomed to seeing? The outcome of Game 1 may very well hinge on how quickly Matheny deploys the hook to pull Wainwright and his compromised throwing arm out of the game.