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Bell: This could be it for John Smoltz

Despite all of his best efforts, John Smoltz could not overcome the curve ball that his throwing arm dealt him. On the disabled list since April 29 with inflammation in his right shoulder, Smoltz did everything possible to try to make it back to help his team. He got a cortisone injection, rested the shoulder and then began a rehabilitative return to a throwing program. He returned in a closing role, in the hopes that shorter outings would allow him to contribute without resulting in excessive pain and inflammation. He even adjusted his arm angle, dropping to a three-quarters pitching motion in an attempt to decrease the stress on the injured tissue. But try as he might, the realities of the physical limitations were simply too great, leading Smoltz to announce that he will undergo season-ending surgery on his shoulder.

Note that Smoltz called it season-ending and not career-ending. Smoltz previously stated that he probably wouldn't return if he had to go through another major surgery. But during Wednesday's much anticipated news conference, he said he is "going to do everything [he] possibly can to continue to pitch." It would not have surprised anyone if he did decide to retire at this juncture. After all, he is 41 years old, has had an outstanding career and has already been through four elbow surgeries and their associated rehab stints. So why come back? Smoltz said he tried to retire once before and was talked out of it (nine years ago!), and he wants to take his time with this situation to ensure that he is not reacting to an emotion.

But determination and perseverance aside, what are the medical obstacles Smoltz faces? The odds for a successful return are certainly not in his favor, but then again, that has not stopped him in the past. We don't know everything Smoltz will face because details as to the severity of the tissue damage in his shoulder will not be known until he actually undergoes surgery, but it is questionable whether he could be ready by Opening Day.

Here's what we do know: The two primary areas of concern for pitchers are the elbow and the shoulder. The most common problems in the elbow are tendinitis, bone spurs and ulnar collateral ligament sprains. Smoltz himself dealt with a variety of elbow ailments, including arthroscopic surgery in 1997, four DL stints from 1998 to 1999 and ultimately a Tommy John procedure (ulnar collateral ligament reconstruction) that caused him to miss the entire 2000 season. Smoltz was clearly able to return and pitch successfully, as many throwers do, following his elbow surgery. Although the rehabilitation from a Tommy John procedure is extensive, requiring a year or longer in most cases, the success rate is overwhelmingly positive. Despite the fact that Smoltz endured three more elbow tendinitis-related DL trips from 2001 to 2003, the overall integrity of the joint after surgery remained solid and his elbow has not given him any major challenges in the past five years.

Shoulder problems are a different matter. They are much more variable in terms of their severity and they can be much more complex to treat, both operatively and non-operatively. The interplay of the rotator cuff musculature (which contributes to the stability of the shoulder in the joint as well as the control of the arm through the entire pitching motion), the biceps tendon (which gets stressed at extreme cocking or wind-up as well as during ball release and follow through) and the labrum (a cartilage ring that helps enhance the depth of the shoulder joint but whose integrity can be compromised by a diseased biceps tendon) is critical in order to pitch effectively. The extent to which each of these areas is damaged will impact what options a surgeon has, and even Smoltz's imaging reports indicated a severely diseased biceps tendon to accompany an inflamed rotator cuff.

Shoulder surgery would threaten any pitcher's career, even if that pitcher were 24 years old. Although they say 40 is the new 30 (and Smoltz's longevity in the game would certainly support that thought), it certainly doesn't hold true when it comes to the inner workings of a pitcher's shoulder. After all, even the renowned Dr. James Andrews, who will perform Smoltz's surgery, can only clean up the joint and make any necessary repairs; he can't restore the remaining tissue to its once youthful pre-pitching-wear-and-tear state. As a result, the successful rate of return after major shoulder surgery is much lower than that following reconstructive surgery for the elbow. One only need look at the challenges and setbacks that aces such as Mark Prior and Mark Mulder have faced following shoulder surgery to appreciate that it is no easy task to make it back to the mound.

All that being said, if there is anyone who has demonstrated the wisdom, maturity and determination to endure a grueling rehabilitative process and return to the mound, it would have to be John Smoltz. His prevailing calm during his news conference amidst what has to be intense frustration with his physical state, and his perspective on his amazing career and accomplishments are what will allow him to be successful. Whether that success means returning to pitch again or whether it translates into moving on to the next chapter of his life, whichever road Smoltz travels undoubtedly will wind its way to Cooperstown. As we often say in the rehabilitation world, it's just a matter of time.

Stephania Bell is an injury expert for ESPN Fantasy. She is a physical therapist who is a Board Certified Orthopedic Clinical Specialist and a Certified Strength and Conditioning Specialist.