Sielski: Phillies have reason to worry about Aaron Nola's elbow

Phillies Pirates Baseball
Phillies starting pitcher Aaron Nola delivers in the first inning against the Pirates in Pittsburgh on July 23, 2016.

There is this photo of Aaron Nola that might sicken your stomach. Gene J. Puskar, a photographer with the Associated Press, took it last year on Saturday, July 23, in Pittsburgh. The Pirates hammered Nola for six hits and six earned runs in four innings during a 7-4 victory over the Phillies that day, and Puskar's photo captured Nola just before he threw one of his 80 pitches. In the shot, Nola already has planted his left foot. His face is twisted in a grimace. His upper body leans forward. He has tucked his glove under his left arm, close to his torso, as he should.

But it's Nola's right arm that is the focus of the photo and the sight that stops you cold. His arm is bent like a backward r, his elbow ahead of his forearm, his hand pronated so that you can see his two-fingered grip on the baseball - an alignment that suggests he is poised to throw a curveball. The strain and torque that he is placing on his elbow as he whips the ball toward home plate are obvious.

Maybe it's a coincidence, but Nola made just one more start last season after that one. He strained his elbow, and the Phillies shut him down. He rested his arm for eight weeks before beginning a rehabilitation program, and he said Wednesday during a media availability at Citizens Bank Park that he was fine now, that he was on a "normal track, a normal schedule," that he was glad he didn't have to undergo Tommy John surgery.

"I would have had to take a year off," said Nola, who went 6-9 with a 4.78 earned-run average in 20 starts last season. "That's a long process. I'm very glad it wasn't anything surgical and it was minor. . . . They got me on a throwing program. I was throwing well through October. After that, I pretty much knew I was going to be good."

What he knows is unknowable, though. And his manager knows it.

"I've talked to him a couple of times," Pete Mackanin said. "He's said, 'Pete, I feel great. I'm well rested. I have no issues with my arm.' But there's always that concern. He had an issue with the arm. He rested it. There was no surgery. There was nothing like that. So you always wonder about that. Therefore, I'm anxious to see how he looks in the spring, and as we get deeper into spring, hopefully he'll have no ill effects and stay strong.

"Then you get into the season, and you always worry, especially about your starters, who you rely on every fifth day. I'm going to be nervous the whole year that one day, [trainer] Scott Sheridan doesn't come into my office and say, 'Pete, his elbow's bothering him.' "

Mackanin's concerns are entirely reasonable. As good as Nola feels, as much promise as he showed over his first 25 starts in the majors (an 11-6 record, a 3.12 ERA, 153 strikeouts in 1552/3 innings), there's a reason that the Phillies have continued to hoard starting pitchers, that they acquired Clay Buchholz and were willing to have Jeremy Hellickson return and may have Jake Thompson and Zach Eflin begin the season at triple A. You never know, especially with a pitcher coming off an elbow problem.

It doesn't matter that Nola isn't a flamethrower, that his average fastball velocity barely exceeds 90 mph, that he vowed Wednesday to be conscientious and cautious with his conditioning and between-starts routine, that he is a smart and tough-minded kid who, when he is right, has a preternatural ability to throw any of his four pitches anywhere he wants. At 6-foot-2 and 195 pounds, he is shaped like a swizzle stick, and while he may never have another problem with his elbow again, that he's already had one - at age 23, in his second major-league season - is enough to give the Phillies and everyone else pause.

Remember: As Jeff Passan noted in his book The Arm: Inside the Billion-Dollar Mystery of the Most Valuable Commodity in Sports, more than 50 percent of all major-league pitchers wind up on the disabled list, and more than a quarter undergo Tommy John surgery:

The elbow scares teams because no matter what they try, it breaks. Throw a lot of pitches and it breaks. Limit the pitches and it breaks. . . . The more teams learn, the more they try, the more frustration mounts because nothing is working. . . . It's not just about pitch count but pitches per inning. And it's not just about pitches per inning but the velocity of those pitches. And it's not just about velocity but the spin rate. And it's not just about the spin but how tired the arm was when spinning the ball. And not just how tired the arm was but how the best of the body compensated for it.

Nola's ERA over his final eight starts last season, before he finally went on the disabled list, was 9.82. He couldn't locate his fastball. His velocity was down. The Phillies can't afford to have him pitch like that again. It's a concern, but it's not the only one. It may not be even the biggest one. Look at that photo again. Look at his right arm. Now, try to tell yourself, despite all of Nola's efforts and the Phillies' best intentions, that Pete Mackanin has no reason to be worried about that knock on his office door.

msielski@phillynews.com

@MikeSielski