BOSTON - Early Tuesday night at Fenway Park, Red Sox team medical director Dr. Thomas Gill addressed the prognosis of Clay Buchholz, who has been diagnosed with a stress fracture of the L2 vertebrae and is questionable to return for this season.
Regarding whether or not Buchholz could potentially be available for either the end of the regular season or the postseason, Gill reiterated what Red Sox manager Terry Francona said earlier Tuesday, suggesting a return was a possibility.
"I think there's absolutely a chance, I just don't know how big that chance is," Gill said. "I think there's a great chance he would be healed by then, or the fracture would be stable by then. The question is how much time does Clay need to get major league ready."
Buchholz will be forced to pass five stages before being cleared to pitch again, a process that typically takes 4-6 weeks (although Gill noted there "hasn't been a reported [injured] L2 in a baseball pitcher"). The issue of whether or not Buchholz could contribute this season may be the lack of preparation time the pitcher will be afforded with the minor league seasons having ended.
"Once he's medically cleared, he then has to get baseball cleared and that's a time frame we just don't know right now," Gill said.
As for when the stress fracture occurred, Gill said, "There's zero percent chance it was there in June. This is absolutely a new injury in July." The doctor also noted that a July 25 bullpen session -- when Buchholz threw in the range of 20-25 pitches -- had nothing to do with the injury.
"Twenty to 25 pitches one time is absolutely not going to cause a fracture," said Gill, who said the injury was most likely a result of the stress put on the portion of the spine by an already pre-existing stress injury.
"There's nothing he did from a baseball standpoint that could cause a stress response to become a stress fracture, except for the fact when you had that long-standing defect on the one side of the ring it's going to concentrate stress on the other," he said. "It was probably just the natural reaction of that stress response."
Whether or not the muscular issue in Buchholz's lower in his back was being caused by the problems in his L2 vertebrae was a subject of some disagreement between the three nationally renowned specialists who were brought in to evaluate the injury. Typically, as Gill pointed out, the L2 wouldn't be affected by something lower in the back due to the support system (tendons, etc.) around it. It is because of that support that would make pitching possible, with other movements perhaps presenting problems.
For Buchholz to return to the mound he would have to not only show the ability to throw pain-free, but not exhibit anything beyond the usual next day soreness a major league pitcher might experience.
"Once he says, 'Look, not only don't I have pain while I'm doing this, but I don't have pain on my recovery day,' that's when we'll move forward," Gill said.
Earlier in the afternoon, Francona explained that Buchholz still has a chance of pitching again this season, although no timetable has been presented.
"It hasn't been ruled out," Francona said. "I don't know. If you see him pitch, he's OK. We'll see."
The manager explained that the diagnosis of the stress fracture was initially identified after Buchholz failed to respond favorably a day after throwing the bullpen session July 25. The injury was then confirmed upon visiting back specialist Dr. Robert Watkins in Los Angeles.
Francona noted that the symptoms are improving, and the injury is stable -- meaning it is expected to heal on its own.
The injury was initially diagnosed as a pre-existing, smaller stress fracture, that was considered something that could be treated as a muscular issue. But following the side session, it was determined that a more serious condition had developed.
"He had a stress reaction. That's why we had three doctors look at him, went to Carolina. I think they all thought it was old. They kept telling us to treat the symptoms, which was muscular, and he couldn't hurt himself. That's why we sent him to so many places," Francona said.
"He went out and threw on that Monday and he threw so well, we all got excited, myself included. He didn't recover very well. He actually wanted to go out and pitch. We're like, 'Slow down.' And I'm glad we did. We got him looked at. It showed there was potentially a stress fracture, we sent him out to Dr. Watkins, he confirmed it and we needed to slow down. That's happening three or four days before the trade deadline, and in all honesty we didn't want to handcuff [general manager Theo Epstein]. I don't think that's fair to him."
Francona reiterated that the injury that is sidelining Buchholz only reached the current level of concern after his bullpen session.
"I think we had a pretty good idea what was potentially going on," the manager said. "He didn't recover quite as well as we wanted to do. He threw the other day and he felt good. He really threw well. We were all excited. But when he showed up the next day and the next day he was feeling sore, if we were going to turn him loose we better be sure about this.
"I think he's realistic. I think it was actually more good news than bad out there with Dr. Watkins. The symptoms show some healing. Again, this is not a career-threatening injury and if you see him pitch this year he's OK."