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Buchholz may face tough road back

BOSTON -- Both Red Sox pitcher Clay Buchholz and team physician Thomas Gill believe it's possible that the injured right-hander could return before the end of the 2011 season, but there are plenty of hurdles he needs to clear before that can even be considered.

The club officially announced Tuesday afternoon that Buchholz has a stress fracture of the L2 vertebra in his lower back, and he's been placed on a strict five-step rehab program developed by back specialist Dr. Robert Watkins, who independently examined Buchholz on Monday in Los Angeles and confirmed what Boston's medical staff already knew.

After consulting with three spine specialists, the takeaway is that this injury is stable, is not career-threatening and will heal on its own without surgery, and Buchholz is expected to be 100 percent for spring training.

Can he pitch again this season?

Potentially, yes, but it really depends on how fast he heals. The key is for his strength to get where it needs to be and for him to be pain-free. If those two things happen, then it is a matter of whether he can return to pitch effectively (essentially, whether he will have enough time to regain his pitching form).

"I think there's absolutely a chance; I just don't know how big that chance is," Gill said. "We absolutely expect him to be 100 percent for spring training."

The Red Sox are in the middle of a pennant race, and pitching will be a key component if the club is to enjoy success for the rest of the regular season and into the postseason.

"If there was a timetable, the postseason would be where I would want to come back. That makes the most sense to me as far as being able to help this club," Buchholz said. "Knowing that I can come back late in the season and potentially help this club win and get to the World Series again is what I'm striving for."

Typically, a bone can heal within four to six weeks. But if Buchholz progresses the way the Red Sox hope he will, they'll be up against the clock because there won't be a chance for a rehab assignment (the minor league schedule will be over by that point).

"Clay being Clay, I know he is absolutely determined to try to get back this year, and it's our job not to let him get back until it's safe for him," Gill said. "They [spinal specialists] all tell us this is a safe problem and he won't injure himself more, so once his strength gets to where it needs to be -- and, more importantly, once he can throw without having pain -- we'll let him come back. If there's enough time left in the season, we'll see."

Buchholz will be on a five-tiered stabilization program (with many components in each tier), focused on training the deep abdominal muscles that help stabilize the spine. The exercises incorporate arm and leg strengthening also, and there is a progression of cardiovascular activity as well.

When the more basic exercises can be performed without any issues, the athlete moves on to more complex, challenging exercises -- with the highest-level activity ultimately being a return to function (movements incorporating extension/rotation, movements necessary for pitching). The key is getting the muscles to activate at a subconscious threshold so they are engaged during all activity to help protect the spine.

According to Dr. Gill, Buchholz had an "old, long-standing" injury called a pars defect, a discontinuity in the bone in the posterior aspect of the vertebra. Gill said it was very clear from the studies they ran in June that it had been there for a long time. These types of injuries can either be acute (triggered by a specific event) or developmental (present from childhood).

Since the vertebra normally forms a closed ring, a defect such as this places abnormal stress on other areas of the vertebra. Opposite of that defect in the pars, Buchholz suffered this latest injury.

It showed up as a stress reaction a month ago. When the symptoms weren't getting better, Gill repeated his studies and "found that stress response had developed into a stress fracture."

Gill did note, however, that the symptoms Buchholz primarily complained of in June were much lower in his back (which doctors attributed to muscular issues), and that that was where the treatment efforts were concentrated. Those particular symptoms reportedly improved, but the lingering issue was primarily soreness that was present the day after activity.

Fellow Red Sox pitcher Josh Beckett is familiar with back issues and knows exactly what Buchholz is going through.

"Backs suck, especially when they don't feel good," Beckett said. "You can't do anything. It makes your whole life miserable. You can't sleep, so you're always tired, and it's tougher to work out and it's tougher to do the things you need to do. Having some closure might help him."