The stress fracture the right-handed starter suffered is not career-threatening. He may even be able to return this season to lift the Red Sox in the playoffs.
"I think there's absolutely a chance, I just don't know how big that chance is," Gill said Tuesday evening in the Fenway Park press box about Buchholz's prospects for making a return this season. "I think there's a great chance that he would be healed by then, or that the fracture would be stable by then. The question then is, 'How much time does Clay need to get Major League ready?'"
Said Buchholz: "If there was a timetable, I think the postseason would be where I'd want to come back. That makes the most sense to me, as far as being able to help this club out."
Gill made clear that there truly is no timetable. Medically, the determining factor in Buchholz's ability to pitch this season will be how quickly the injury heals itself. He can't feel any pain while pitching, Gill said, and he has to be able to recover after pitching as he normally would, in four days. The injury doesn't bother Buchholz on the mound, it bothers him the next day.
"If I feel anything throwing there's no use in throwing, because it's just going to re-aggravate that area," said Buchholz, who hasn't pitched in more than six weeks. "So I think it's going to be a pain-free type of thing, once I get to one level and go to the next, ease your way into it, step by step."
There are actual defined levels Buchholz will be working toward. He's been given a five-step conditioning plan with a focus on core exercises that he started on Tuesday. The plan has him working for four days straight, then resting on every fifth day.
The stress fracture Buchholz is battling now appears to have been caused by one he had a long time ago, called a "pars defect."
"Clay, on one side, has an old, long-standing injury called a 'pars defect,' which is a discontinuity in the bone in that area that I mentioned, the pars interarticularis," Gill said. "There's a lot of different things that can cause it. It can be an acute injury, or you can get them from childhood, just something developmental. But it's very clear in the studies that we've got that that's been there for a long time."
When Buchholz suffered that is almost inconsequential, because that's not what was bothering him in June. Not directly, anyway.
"We sent him to see a couple of our spine specialists that he worked with. They confirmed that, yes, he had the bony injury above," Gill said, "but that most of his symptoms were coming from below that."
Buchholz first went on the disabled list this season on June 19 (retroactive to June 17) with a lower back strain. The description of that injury, Gill said, is accurate: There was indeed a muscular injury.
But between June and the last week of July, Gill put Buchholz through another round of testing -- a CAT scan, an MRI, a bone scan -- after he was sore following a side session at Fenway on July 25. He had suffered another fracture because the first one had caused a stress reaction that itself turned into a stress fracture.
"If you think about a chain that has a break in one part of the chain, it's very hard to break a chain in one area," Gill said. "Or if you think of a pretzel the same way: You can't break a pretzel in one place, it needs to break in two. And so if you have a defect on one side of that chain or that ring, it adds stress directly opposite to the other end of the ring, and that's basically what Clay has."
Gill was positive that the recently discovered injury was also suffered recently, saying there was a "zero percent chance it was there in June." The specialists had some disagreement about whether the muscle injury was related to the stress fracture.
If Buchholz did not pitch again this season, he is expected to be 100 percent by Spring Training next year. For Buchholz, who's 12 days shy of his 27th birthday and has not made more than 28 starts in any season, the current situation isn't pleasant.
"I've been frustrated for a while. I want to go out there," he said. "I want to pitch, that's why I'm here, that's why they gave me the [four-year, $30.5-million] extension they gave me earlier this year, is to go out and help this team win. And for something like this to happen after last year, after being hurt for a month with the hamstring, it's frustrating. Definitely not something that I wanted to happen, but I do believe everything happens for a reason."
Buchholz, 6-3 with a 3.48 ERA, said he hasn't talked to other athletes who have had this same injury. He was encouraged, though, when he visited Dr. Robert Watkins in Los Angeles on Monday, and saw the jerseys of other athletes he had helped.
"Josh Hamilton's jersey was in there, a bunch of football players, Eli Manning," Buchholz said. "You see all the stuff that's shown in there and how positive they were after the fact that he diagnosed them with whatever he diagnosed them with, and they're back on the field and better and playing. That's all I needed to see."