He had been told surgery was optional, but by taking the "no" option, there was always risk involved. The risk would be simple: The pain would persist.
"I just felt that I wanted to pitch as long as I could the way it is and if it is something that I could manage, then I'm going to manage that way," Grabow said.
As have most of the relievers in the Pirates bullpen, Grabow has extended his workload through these first two weeks of the season because of the number of extra-inning contests the team has already had to play. So that poses the obvious question: Are there any signs that the elbow can't endure the heavy workload?
"Everyone is working through their little pains," Grabow answered. "I'll feel a little achy, but nothing more than in the past."
The lefty appeared in eight of the team's first 12 games this season, logging a total of 8 2/3 scoreless innings. Neither of the two runners that he has inherited has scored. And not only has he been keeping runs off the scoreboard, but Grabow has been doing so dominantly.
Right-handed hitters have just three hits in 22 at-bats. Left-handed hitters are 2-for-11. Grabow's ability to get right-handed hitters out has also been an asset manager John Russell has taken advantage by being able to call on Grabow for more than just a matchup role late in games.
Grabow and Russell both point to Grabow's fastball command as the difference in his early success. That fastball command has allowed Grabow to regularly get ahead of hitters, and as a result, he has fallen into fewer deep counts than he had in the past. He's given up just two walks.
"He's got a great idea of what he wants to do when he comes in," Russell said. "He's very well prepared. The consistency of what he's been doing has been great. He's really taken a step forward."
With his heavy workload so far, Grabow entered Monday's game against the Dodgers on pace to pitch in 108 games. And while of course that pace won't continue, is there such thing as being overworked at the onset of the season? Grabow shook his head.
"You'd rather pitch a lot than not pitch at all," said Grabow, whose career high in appearances is 72, which he set in 2006.
Grabow had altered his offseason workouts with the hope of increasing his durability so that he could hit that 70-appearance mark again. He focused more heavily on strengthening his shoulders and legs with the intention of taking some of the wear and tear off his elbow this season.
Additionally, Grabow lauded Russell's management of the team's relievers, and he cited that management as the reason why he's not concerned about having to have played a role in so many games so early.
"He isn't getting us up and down a whole lot down there. If we get up, we're usually coming into the game," Grabow said. "In the past, it wasn't always like that. You'd warm up twice and then get in the game. You start to get tired.
"But he hasn't been doing that to any of us and that means a lot to the bullpen. And hopefully we'll be able to be fresher toward the end of the season as a result."
Jenifer Langosch is a reporter for MLB.com. This story was not subject to the approval of Major League Baseball or its clubs.