Doctors and trainers gave him the green light, but Daisuke Matsuzaka didn't know what to do.
Last June, a year removed from Tommy John surgery on his right elbow, he returned to the mound for the Red Sox. His body had healed, but it had yet to sync with his mind.
"It was a daily battle figuring out how I felt, how my elbow felt and how my body felt," Matsuzaka said earlier this month from Goodyear, Ariz., the Spring Training home of his new team, the Indians. "People around me last season told me [I was] fine, but I was still trying to figure it out, within myself, how much my body could do and what condition it was in."
Pitchers who undergo the ligament-replacement surgery face different recovery processes and results. Some never find their form. Some come back throwing harder. For many, it's all about taking the time to rediscover the symbiosis between mechanics and mindset.
Once a pitcher finds harmony on the mound, the argument can commence: How many innings can he throw in his first season back?
The Nationals don't plan on harnessing Stephen Strasburg again this season, but there are a host of hurlers who could encounter an innings cap during their returns from elbow surgery.
Washington general manager Mike Rizzo initially set a well-documented ceiling of 180 innings for the hard-throwing Strasburg in 2012. When the club sensed the right-hander was fatigued, it shut him down in early September, curbing him just shy of 160 innings despite the Nats' first-place standing.
This year, Strasburg is embracing the opportunity to be the team's workhorse.
"It's going to be a challenge. It's going to be a test, and I think I'm ready for it," Strasburg said. "I trained really hard this offseason. Hopefully, I'll answer the bell, throw 200-plus innings and be the guy in the rotation that can be reliable -- go six, seven, eight, hopefully nine innings every time out this year. ... I want them to know that I'm going to be 100-percent ready. If you want me to go out there and go for another inning, I'm your guy."
Mike Pelfrey desires similar control over his own workload. The former Mets right-hander, who underwent Tommy John surgery on May 1 and joined the Twins on a one-year contract in December, said he'll be ready for Opening Day.
Pelfrey, though, prefers that his arm dictate when he should cease pitching this season, rather than be subjected to a predetermined limit.
"My whole thing is if I get 160 and I'm tired, I'm going to end it and tell them I'm tired," Pelfrey said. "If I get to 180 and I feel good, I'm going to keep going. As long as I feel good, I'm going to keep doing it. I've busted my butt and worked my tail off to get back. I don't think if it gets to 200 it's going to be an issue. I've done it before."
Like Dice-K, Carlos Carrasco is one of many starting pitchers vying for a spot in the back end of the Indians' rotation. The native of Venezuela had Tommy John surgery on Sept. 14, 2011.
"[This spring] will be a gauge for us to see if he's ready to try to help us win games," Tribe skipper Terry Francona said. "He's on the same path as everybody else right now. There's not a limit on him or anything like that."
Carrasco made a few brief Minor League appearances toward the end of last season, and reportedly touched the mid-to-upper 90s on the radar gun. He surrendered four runs (three earned) in a shaky first inning of the spring on Sunday, but Francona likes what he has seen from the right-hander.
"[It] looks like the hard work has paid off," Francona said. "The ball is just live out of his arm. You try not to get overly excited when you watch guys throw, but it's hard not to."
Danny Duffy and Felipe Paulino, a pair of hard-throwing hurlers for the Royals, had surgery about three weeks apart last summer. Each is targeting a return around the All-Star break. With the offseason additions of James Shields, Ervin Santana and Wade Davis, however, the Royals could stow Duffy and Paulino in the bullpen, which might ease their transitions back to the mound and give Kansas City depth down the homestretch of the season.
Brett Anderson provided the Athletics a similar lift last season, albeit in a starting role. The southpaw had surgery in July 2011 and returned to the big league club just in time for Oakland's playoff push. Anderson went 4-2 in six regular-season starts during August and September and won Game 3 of the American League Division Series against Detroit.
This year, he doesn't expect to have any restrictions.
"The way he finished up last year, we're obviously very optimistic about what he can do for us this year," A's pitching coach Curt Young said. "You go through that injury and you basically put two years of rehab in. He's beyond that and he can just worry about making his starts, which is good for Brett, good for us."
Red Sox manager John Farrell rewarded John Lackey for his diligence during his recovery from November 2011 Tommy John surgery by handing the righty the ball for Boston's Grapefruit League opener.
Lackey racked up a 5.26 ERA in the first two seasons of his five-year, $85 million pact with the Red Sox and then missed the entire 2012 campaign. While rehabbing from his injury this offseason, he dropped 17 pounds, which eases the burden of each outing on the mound.
"He's felt great physically," Farrell said. "His arm has shown the looseness we're accustomed to seeing with the Angels and really his first year here. I know one thing, he feels really good about himself from a physical standpoint, and it's translated into some confidence right now."