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On February 5, 2020, it was revealed that Paxton underwent a microscopic lumbar discectomy to remove a peridiscal cyst. Recovery time required 3-4 months.

A power pitcher with a long stride and a 3/4 release from a closed position that hides most of his deliveries, comparable to a faster version of Andy Petitte, Paxton relies on a four-seam fastball that ranges in velocities in the high 90s miles per hour (MPH). He also complements his four-seam fastball with a cutter (high 80s MPH) and a knuckle curve (low 80s MPH). He has decreased the use of his sinker/changeup. His strikeout pitches are high fastballs and a low inside knuckle curve against right-handers. His increased usage of knuckle curves on the first pitch of at bats limited the amount of hits and runs that he allowed during the end of the 2019 season. However, his glove position pre-pitch made it easy for a knuckle curve to be tipped, so he now puts the glove sideways while wriggling the ball and the glove.

Paxton played college baseball for the Kentucky Wildcats. He was drafted in the fourth round of the 2010 MLB draft by the Mariners and made his MLB debut for them in 2013. On May 8, 2018, Paxton pitched a no-hitter against the Toronto Blue Jays, becoming the first Canadian major league pitcher to throw a no-hitter in Canada. Following the 2018 season, Paxton was traded to the Yankees.

In 2018, before his start against the Minnesota Twins, Paxton gained national media attention when a bald eagle, which had been participating in a patriotic pre-game ceremony, flew around and landed on Paxton. Paxton, who reacted unusually calmly, later stated, "No, I wasn't going to run. I figured I'm not going to outrun an eagle, so I might as well see what happens." On May 2, 2018, against the Oakland Athletics, Paxton struck out a career-high 16 batters, but the bullpen behind him faltered, and the Mariners lost 3–2.

On May 8, 2018, Paxton threw a no-hitter against the Toronto Blue Jays. He threw 99 pitches while issuing three walks in a 5–0 victory. He was the second Canadian to throw a no-hitter, being the first since Dick Fowler of the Philadelphia Athletics did so on September 9, 1945 vs. the St. Louis Browns. He is also the first Canadian Major League pitcher to throw a no-hitter in Canada, and the first Seattle Mariner to throw a no-hitter in a road game. He was placed on the disabled list on July 13, 2018 with a back injury. He finished the season 11–6 with a 3.76 ERA.

On November 19, 2018, the Mariners traded Paxton to the New York Yankees for Justus Sheffield, Dom Thompson-Williams, and Erik Swanson. In April 2019, Paxton became only the second Yankees pitcher (after David Cone in 1998) to strike out 12 or more batters in consecutive starts. In 2019 he was 15-6 with a 3.82 ERA in 29 starts, in which he struck out 186 batters in 150.2 innings (11.1 strikeouts per 9 innings).

Paxton started the 2017 season for the Mariners with 0.00 ERA over his first three starts. He won the American League Player of the Week Award for April 10–16 after pitching a combined 15 scoreless innings in two wins. On May 5, 2017, Paxton was placed on the 10-day disabled list due to a left forearm strain. Paxton pitched exceedingly well in July, going 6–0. He and Adrián Beltré were the co-winners of the American League Player of the Week Award for July 24–30, and he was also the AL Pitcher of the Month for July. However, on August 10, Paxton strained his left pectoral muscle pitching against the LA Angels, putting him on the disabled list once again. He tied for the major league lead in wild pitches, with 15.

Paxton began the 2014 season in the Mariners rotation, but after his first start of the season, he was placed on the disabled list. He would finish the season appearing in only 13 starts due to an extended stint on the disabled list. His injury woes would continue into the 2015 season, during which he would appear in only 13 starts for the second consecutive season. In 2016, Paxton was in competition for a rotation spot in spring training, but after posting an ERA of over 9, he was optioned to AAA. He was recalled a few months later after Félix Hernández landed on the disabled list.

Paxton attended Delta Secondary School in Ladner, British Columbia. He played for the North Delta Blue Jays of the British Columbia Premier Baseball League (PBL) and for Team Canada at the Junior National level. In his junior year, Paxton won 10 games and had a 1.51 earned run average (ERA) to go along with 100 strikeouts in 78 innings pitched. This led to him being named the top pitcher of the PBL and a first-team All-Star. After starting his senior year injured, Paxton finished the year with a 7–1 win–loss record and 65 strikeouts and 32 walks in 50 innings pitched. Both years Paxton and the Blue Jays won the league title and the B.C.'s Best Tournament.

In 2013, Paxton played for the Tacoma Rainiers of the Class AAA Pacific Coast League. With the Mariners' coaching staff, he worked to change his pitching mechanics to mirror that of Clayton Kershaw, resulting in an improvement in his performance. On September 3, 2013, Paxton was promoted to the major leagues. His first major league appearance came on September 7 when he started against the Tampa Bay Rays. He earned the win as the Mariners won 6–2. Paxton finished with a 3–0 record in 4 starts.

In June 2010, Paxton was drafted by the Seattle Mariners in the fourth round of the 2010 Major League Baseball Draft. He signed with the Mariners on March 4, 2011. In the 2011 season, Paxton played for Single A Clinton LumberKings and the Double A Jackson Generals of the Southern League. He finished with a 6–3 win–loss record, 2.37 ERA, 131 strikeouts, and 43 walks in 95 innings pitched, while allowing an opposing batting average of .215. Paxton, along with Alex Liddi, represented the Mariners at the 2011 All-Star Futures Game. Paxton was invited to attend the Mariners' main spring training camp in 2012, but did not make the opening day roster. He was sent to the Jackson Generals.

After being ruled ineligible to return to Kentucky, Paxton signed with the Grand Prairie AirHogs in the independent American Association in 2010. There, he went 1–2 with a 4.08 ERA and striking out 18 batters in ​17  ⁄3 innings.

Paxton started 13 games in 2009, finishing 5–3 with 115 strikeouts (5th best in school history) in ​78  ⁄3 innings. He drew the attention of Major League Baseball scouts as he was considered a possible first-round draft pick. Paxton was drafted by the Toronto Blue Jays in the first round (37th overall) of the 2009 Major League Baseball Draft. However, he did not sign with the Blue Jays opting to return to Kentucky for his senior season; the NCAA subsequently ruled him ineligible, stemming from his contact with agent Scott Boras.

In 2008 as a sophomore, Paxton worked his way into the starting rotation midway through the season and earned 11 starts while making 17 appearances. He finished the year 4–2 with a 2.92 ERA. That same year Paxton pitched a complete-game shutout over Ole Miss to win the SEC Tournament earning him SEC Pitcher of the Week. Due to injury, he did not participate in the NCAA Tournament. That summer Paxton was invited to play collegiate summer baseball in the Alaska Baseball League where he pitched in four games with three starts, finishing with a 1–0 record and a 2.25 ERA in 16 innings. He struck out 12 batters and allowed opponents to hit just .179 against him.

After graduating high school in 2006, Paxton attended the University of Kentucky, where he played college baseball for the Kentucky Wildcats baseball team in the Southeastern Conference (SEC). As a freshman, he led the Wildcats in appearances with 25 and had a 2–0 record in relief with one save.

James Alston Paxton (born November 6, 1988), nicknamed "The Big Maple", is a Canadian professional baseball pitcher for the New York Yankees of Major League Baseball (MLB). He previously played for the Seattle Mariners from 2013 to 2018.