SEATTLE -- One of the critical questions facing the Mariners this offseason isn't new, but it does loom large. Can James Paxton stay healthy enough to anchor Seattle's rotation going forward?

Even as Paxton has developed into one of the most dominant left-handers in the game, that query has been constant for the past four years. And now, coming off a season in which he was in the conversation for the American League Cy Young Award until getting derailed again by an injury, the Mariners must determine how much they can count on the big Canadian.

"In James' case, I think most of his trips to the DL, most of his missed time has been largely unpredictable," said general manager Jerry Dipoto. "They are very unique injuries, and there's nothing that you can really foretell."

Indeed, Paxton's injury history is a curious collection of calamities. The good news is he hasn't been hampered by an ongoing issue with his elbow or shoulder that requires surgical repair or proves degenerative over time. The bad news is he seems to be either injury-prone or just plain unlucky.

In 2014, Paxton missed nearly four months with a strained lat muscle in his upper back. In '15, he sat out 3 1/2 months with a strained tendon in his left middle finger and then dealt with a severely torn nail on the same finger when he returned.

In 2016, Paxton opened the season in Triple-A Tacoma for two months, but he was putting things together impressively in August when he got hit in the elbow by a line drive that landed him back on the disabled list.

This past year, Paxton came out of the gates with an overpowering April and was 3-0 with a 1.43 ERA after six starts before a strained forearm forced him out for four weeks. He was back on track by July when he earned AL Pitcher of the Month honors after going 6-0 with a 1.37 ERA, but then he strained the pectoral muscle in his left chest on Aug. 10 and missed another five weeks right as the Mariners were trying to make a push for a Wild Card berth.

When Paxton was able to stay on the mound, he put up imposing results, going 12-5 with a 2.98 ERA and 10.3 strikeouts per nine innings. But the two DL stints limited the 28-year-old to 24 starts and 136 innings, once again leaving an asterisk on his success.

"That was kind of the story of the season for me," Paxton said. "When I was out there, it was pretty good, for the most part. Obviously, the goal for me is to stay healthy and get those 33 or 34 starts in a season. So that's what I'm going to be focusing on this offseason, finding a way to stay healthy for an entire season. Because that's what we need out of me."

An improved diet and workout program has helped Paxton get stronger on the mound. Now he just needs to figure out how to stay there, and he's ready to turn over every stone this winter to find answers. Paxton has done a lot of hot yoga conditioning to improve his flexibility in the past, and now he'll add in some kinesiology testing to see if there's more he can do to keep his muscles healthy.

"I'm going to try some different things," Paxton said. "I'm going to find out what muscles my body uses, which ones I put more on and what needs more extension and go from there to the workouts. I'm also doing some blood testing to find out if there's anything I need in my diet to help my recovery and stuff like that, and some other things we'll be looking at as well."

In other words, whatever it takes, Paxton is ready to try.

"I'm going to nerd out big-time and do whatever in my power I can do to stay healthy," Paxton said. "I feel like I've made positive steps with my diet and everything. I just think there's more I can do. I haven't done the blood testing before. Finding out if there's something I don't know about myself. It's just about learning and trying to find what works for me."

And if it all comes together, the Mariners will be thrilled.

"This was an up-and-down year with the injuries for him, but performance-wise, he really took the next step," manager Scott Servais said. "I look forward to having him for a complete season next year. That is the goal."