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Friday, September 21, 2012
Carpenter makes surprising return to action

Amazing. There is no other way to describe the return of St. Louis Cardinals ace Chris Carpenter to the mound just two months after undergoing major surgery.

Carpenter is making his season debut this afternoon at Wrigley Field as the Cardinals visit the Chicago Cubs. The last time Carpenter pitched in the majors was Game 7 of the 2011 World Series. Friday's game might not have the same competitive implications, but the significance of Carpenter taking the mound is perhaps greater.

Chris Carpenter
Chris Carpenter may only have marginal fantasy value for the last couple of weeks of the season, but it does set himself up for good things in 2013.

His season was over, or at least it appeared to be, before it ever had a chance to start. Carpenter dealt with persistent weakness in his throwing shoulder for months dating back to spring training. The symptoms had been present off and on for several years but worsened in 2012. In early July, just prior to the All-Star break, I wrote this about Carpenter's status:

Despite taking some positive steps in his return to throwing, Cardinals ace Chris Carpenter continued to experience episodes of weakness in his throwing shoulder. That led to consultation with a vascular surgeon in Dallas and a diagnosis of thoracic outlet syndrome, a condition not uncommon in pitchers where nerves and/or arteries between the neck and shoulder can be compromised, resulting in symptoms into the arm. In Carpenter's case, there is no immediate surgery planned, suggesting the source of the symptoms is more neurogenic (nerve-related) than vascular (circulatory). "If I can pitch, that's what I'm going to do," Carpenter told the St. Louis Post-Dispatch. "If I can't, then we come up with another plan."

Two weeks later, Carpenter had surgery. The procedure involved removing a rib contributing to compression of nerve tissue in the area between his neck and shoulder. The idea behind the procedure is to free the involved nerves in order to alleviate symptoms -- usually numbness, tingling and weakness -- in the shoulder, arm and hand. Recovery is often slow and unpredictable. There has to be restoration of normal range of motion in the entire upper quadrant (neck, upper trunk or rib cage area, shoulder, arm and hand), as well as normal strength. Depending on the extent of nerve involvement and the amount of time the condition has been present, regaining full strength can take anywhere from weeks to months. Return to sport, truly the final phase of rehabilitation, typically takes anywhere from three to six months or longer.

In Carpenter's case, a firm timetable was avoided largely because of the variance between individuals. Carpenter's incredible work ethic turned out to be an important element in his rapid progress. As Carpenter told the Cardinals' official website, "When you have injuries you find a way to get through them ... I don't take a day off. I make sure I do what I have to do to get back as fast as I can."

And it wasn't just what he did after the surgery. Carpenter maintained his conditioning to the extent possible while on the DL, making his recovery and return to pitching easier. He then progressed through rehab as quickly as his body would allow. After throwing side sessions and participating in simulated games, Carpenter had shown his coaches enough for them to feel comfortable returning him to a starting role.

He allowed two runs and five hits over five innings in his first start of 2012, further inspiring confidence in him. This is the same guy who in his first full season following Tommy John surgery was in the running for the NL Cy Young award. He has never let his injury history, extensive as it is, define him. This may be perhaps the biggest reason why the 37-year-old pitcher is once again defying expectations.