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FORT MYERS, Fla. — There’s no in-between for Chris Sale when he takes the mound. Everything is done at top speed. Full throttle. He possesses a three-pitch mix: fastball, changeup, and slider. Sometimes he’ll mix in a sinker, but in most cases it’s nothing fancy, just dominant. He relies on power and conviction, and he has no problem living with the results.

Sale portrayed all those qualities Thursday, except the last one: He had trouble coming to terms with this outcome.

Sale has been diagnosed with a flexor tendon strain in his left elbow and he’ll be shut down for 10 days and then be reassessed.

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“It sucks,” Sale said. “Obviously, I don’t want to be sitting here giving you this information. It’s a tough spot, myself, this team, and the organization going forward.”

In a game ruled by stoicism, Sale follows his own guide. He’s unapologetic in his feelings and has no problem sifting through them in a public setting. He acknowledged not having all the answers, and he understood that joy and hope can sometimes rub shoulders with pain and disappointment.

“There’s optimism to be had,” Sale said. “I’m thankful for that. But I know the situation that we’re in right now and it’s not fun. I know there’s an expectation level that our fans, my team, you guys, and myself hold me to, and I haven’t met that. I haven’t. This is about as tough of a situation as I’ve ever been in.”

Sale missed the end of last season because of elbow inflammation that cropped up after his Aug. 13 start against the Cleveland Indians. He hadn’t pitched to hitters again until this past Sunday, and again Sale felt some of the same symptoms. The Red Sox sent him for an MRI, followed by a second opinion from Dr. James Andrews, and a third from Dr. Neal ElAttrache, and it gave the Sox more clarity on how to navigate moving forward. If and when Sale does throw again, the Sox hope he’s beyond this, but they know that’s not a guarantee.

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“Everybody thought that, with the imaging, that this is the way we should go,” manager Ron Roenicke said. “They thought, 'Let’s give it a try and see where we are.’ Hopefully, he’s right back on track and this was just a setback and we could get him to continue and get through the year and hopefully years to come.”

For now, the worst-case scenario with Sale has been avoided — though the ace isn’t necessarily out of the woods.

A flexor tendon strain usually results in a prescription of 4-6 weeks of rest and recovery, and there are examples of pitchers with flexor strains returning to the mound without surgery. In 2016, for instance, lefthander Andrew Miller suffered such a strain in June, but he was back in games after roughly a month, and concluded that season as a postseason force for the Indians.

However, there have been numerous instances of pitchers being diagnosed with flexor tendon strains but seeing little improvement during the rest period and ultimately undergoing Tommy John surgery. In recent years, Red Sox reliever Carson Smith and prospect Jay Groome were diagnosed with flexor strains, and they both ultimately required the operation.

Last year, lefthander Rich Hill (then of the Dodgers) was diagnosed with a flexor strain. He returned to the mound after two months for three regular-season appearances and one playoff game, but after the season he required Tommy John revision surgery. After the surgery was performed, Hill was told that his flexor tendon had been fine, and that the strain (tearing) that had sent him to the injured list had been in his ulnar collateral ligament.

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In a best-case scenario, Sale’s diagnosis means that he would be able to pitch in games by May — a timetable similar to the one that David Price followed in 2017 when he suffered a tendon strain after throwing his first live batting practice of the spring. In a worst-case scenario, this diagnosis might merely delay surgery if Saledoes not respond well to rest, an obvious possibility given that his 2019 season ended because of an elbow injury and his first time on the mound against hitters since then — already delayed by pneumonia — resulted in elbow discomfort.

“That’s the tough part in this whole situation,” Sale said. “Guys talk about the pitch or the pop sound or the feeling they have. The frustrating part for me is that I never had that. There was never one pitch that I threw and I was like, ‘Oh crap, that was it.’ That’s what kind of makes this situation a little bit harder. If I said, ‘Hey, there was this one slider, one changeup, one fastball I threw.' They’d be like, ‘Oh, well, go up to Pensacola [to get the Tommy John surgery done by Dr. Andrews] and we’ll see you in a year.’ ”

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The gray area doesn’t fit Sale’s personality. On the mound, he’s direct in his thinking on how to attack hitters. He doesn’t want to nibble around the plate’s edges. He salivates at the idea of putting his opponents away as quickly as possible with his best stuff. He doesn’t question anything, but now he’s left with many questions. He can’t control the results.

Guilt spilled out during Sale’s news conference. He talked about sitting in the same press room at this time last year when the Sox announced his five-year $145 million contract extension. He spoke about how terrible he feels that he won’t take the mound at a time when his team is in desperate need of starting pitching. He intimated how he feels he’s letting his team down, though none of it is his fault.

“Well, try telling everybody that,” Sale said of unfairly blaming himself. "I have an expectation level. That’s never changed and they put faith in me and I messed up.”

The team will trudge on without Sale for now. They’re left with Eduardo Rodriguez, Nate Eovaldi, Martin Perez, perhaps newly acquired Collin McHugh, and an opener in the rotation. Just think, this was a team that won the World Series in 2018 largely because of its starting staff.

As for Sale, he’s hoping he could be ready at some point this season. Yet he’s also not avoiding the fact that his fate might include surgery.

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So, when it’s time to take the mound for another bullpen session or live batting practice this year, Sale will let his pitches rip. Anything else would be inauthentic to his persona. If his elbow tears, so be it. He refuses to tip-toe around darkness. In the end, he’ll have his answer — good or bad.

“I can’t give this a 90 percent effort and be OK with that,” Sale said. “That’s not who I am. That’s not how I ever played this game. You watched any game I played, it’s everything I got until the manager takes the ball out of my hand. That’s what I got to get back to. Whether it works or doesn’t, I’m not afraid of the other side.”






Julian can be reached at julian,mcwiliams@globe.com. Follow him on Twitter @byJulianMack Alex Speier can be reached at alex.speier@globe.com. Follow him on twitter at @alexspeier.