BOSTON -- It is not a question of whether Carl Crawford will have Tommy John reconstructive surgery on his left elbow. It is a question of when, although the Red Sox still dispute that notion.
Crawford told ESPNBoston.com's Joe McDonald a couple of days ago that if he can't handle the pain in the elbow, he'll "probably" have surgery to repair a sprained ulnar collateral ligament after the season. He has told friends, a baseball source said Saturday, that doctors have told him he will need the operation.
"That is false," general manager Ben Cherington said in an e-mail late Saturday afternoon. "It's a possibility down the road, but plenty of position players play with UCL injuries."
Crawford has been on a rehab assignment, preparing to return to play after the All-Star break. That schedule was interrupted Saturday, however, when manager Bobby Valentine said the Sox are shutting down the outfielder because of a minor tweak to his groin, which the manager claimed happened while he was legging out a triple Thursday night in Double-A Portland's game in Manchester, N.H.
But there is a bigger issue here for the Red Sox, one that is being cast into greater relief as the Sox fade farther behind the Yankees in the American League East. Are the Sox -- and Crawford -- doing the right thing by having him try to play through the pain as they try to make a run for a postseason spot, or would Crawford and the team be better served by having the surgery sooner than later, allowing Crawford to return fully healthy by the start of the 2013 season?
Cherington is correct in this respect: There have been position players who have played through the injury. One was Albert Pujols, who sprained his UCL in 2003, early in his career with the Cardinals. Pujols played some outfield, with instructions from manager Tony La Russa to flip the ball lightly either to the shortstop or center fielder.
"If it doesn't work, if something goes wrong, I'll quit," La Russa said at the time. "You won't have to fire me."
But Crawford's teammate in Tampa Bay, outfielder Rocco Baldelli, sprained his UCL in June 2005, and soon thereafter had surgery, missing the entire '05 season (he began it on the DL after offseason ACL surgery) and not returning to the Rays until the following June.
Crawford has worked tirelessly to put himself in a position to play this season, first after undergoing wrist surgery in January, then after spraining the UCL in his elbow, an injury he said he first became aware of while the Red Sox were still in spring training.
In an attempt to facilitate healing, Crawford received a platelet-rich plasma injection. PRP therapy for tissue injuries is a fairly recent development for professional athletes, and its effectiveness is still debated. Golfer Tiger Woods and pro football players Hines Ward and Troy Polamalu are among the athletes who have undergone the treatment.
Crawford said Friday that he doesn't believe the injection helped significantly.
"At this point, that injection I got didn't really do too much," he said. "I'm at a point now that I can get by with it, so I'm going to try to do that."
Signed to a seven-year, $142 million contract as a free agent after the 2010 season, Crawford suffered through a disappointing debut season with the Sox in 2011, batting a career-low .255 and posting a .694 OPS, his lowest since he became an everyday player for Tampa Bay in 2003.
He has told management that he would like to play this season and do what he can to help the club, which fell back to .500 after a 6-1 loss in the first game of Saturday's day-night doubleheader. But in his visit to Boston this week, he acknowledged that the elbow remains a concern.
"It's not 100 percent healthy," Crawford said. "But I'm ready to hit, so I've said whenever I'm ready to start hitting the ball, then I'll play. There are still some issues with the elbow."
Those issues will have their greatest impact on his throwing; Crawford doesn't have a strong throwing arm to begin with, and it's clear he'll be even more limited by the elbow.
The question then becomes whether he can contribute enough offensively to make putting off surgery worthwhile. There is no certain answer, especially considering that his situation is compounded by the fact that players recovering from wrist surgery often are challenged to regain their previous form, and that he probably will be under self-induced pressure to erase the memory of last season's subpar performance.
Crawford was to have played in Pawtucket this weekend, but now he will have to wait a minimum of seven days before resuming his rehab program, which could delay his return to the Sox's lineup to near the end of the month.
Jacoby Ellsbury, who has been out since April 14 with a partially dislocated right shoulder, also is rehabbing and may be activated as soon as next weekend. The Red Sox activated Ryan Sweeney (inflamed toe) for the second game of Saturday's doubleheader, and Scott Podsednik (groin) also is ready to resume playing. Daniel Nava has played above expectations and Ryan Kalish is healthy again (though he was sent back to Pawtucket on Saturday to make room for Sweeney).
So how urgently is Crawford needed? If he was the "game-changer" that he was advertised to be when he first signed, then obviously his impact could be decisive in Boston's quest for a postseason spot. But given his struggles last season, and the fact that he would be less than 100 percent physically for the balance of the summer, it is a questionable proposition how much the Sox would gain from Crawford's return.
His desire is admirable, but as painful as it would be to chalk up 2012 as a lost year, it might be the wisest course. For Crawford, and for the team. Then hope that 2013 hasn't been jeopardized by waiting this long.