Buchholz is Back! Sox AL Pennant riding on “Back of Clay”

For the citizen of Red Sox Nation, whose pitching is limited to weekend pick-up games, who is familiar with Monday Morning back pain, it may be time to learn more about the muscle and marrow details of the Buchholz back, as the Sox pennant chances may be riding on it.

Last August Buchholz was initially diagnosed [three times?] with “back strain,” which typically refers to a problem with the muscles of the lower back and was placed on the 15-day DL.

“A low back muscle strain occurs when the muscle fibers are abnormally stretched or torn. A lumbar sprain occurs when the ligaments, the tough bands of tissue that hold bones together, are torn from their attachments. Differentiating a strain from a sprain can be difficult, as both injuries will show similar symptoms. Many doctors refer to both injuries as a category called “musculoligamentous injuries” of the lumbar spine.” [1]

As any weekend warrior hurler knows, lying flat and taking a pain reliever will get you back on your feet again the next morning, usually. And, worst case, so long as the problem is muscular in nature,– and you pitched batting practice for your child’s team, or kept pitching in that pick-game, after it started to tighten up between innings–it may require two days flat on your back with medication. But, if the pain requires you to go on the DL for longer, say more than two weeks, it is likely that the problem is more than just strained muscles.

After 15 days on the DL were was sufficient time for his back to heal, Buchholz was moved to the 60 day DL; it was then that he wisely decided to seek an independent medical opinion, outside the in-house trainers, to determine why he wasn’t getting better.

On August 1st he was examined by August 1, Dr. Robert Watkins, a Los Angeles-based specialist, to seek a fourth opinion on what had been thought to be a lower back strain.

Dr. Watkins’ diagnosis was that the problem was not just muscular, but also involved bones in the lower back; Buchholz was suffering from “Spondylolysis,” or a “stress fracture.” The difference between a strained back [muscle] and a stress fracture [bone] is 2 or 6 weeks on the DL.

A stress fracture is a great deal more serious than a muscle strain, but not as dire as a complete fracture of a bone in the spine; a stress fracture is caused by repeated physical motion [think pitching]. Typically a fracture is caused by a traumatic event [slipping on ice and landing on your tailbone], but a stress fracture is caused, gradually, over a period of time by putting a brief, but intense weight load on a bone on a frequent basis [think landing on your front foot and wrenching your body forward at 90 MPH about 100 times in 2 hours.]

Typically, Spondylolysis, results in bone damage bone damage, where repeated fatigue eventually causes microscopic cracks to occur in a bone in the back. [Most commonly, the Pars]

“In healthy bone, if damage is not excessive, a biological process called remodeling occurs and new bone is deposited to heal the damage. In order for remodeling to occur, the body must be given adequate rest to recover from the repeated loading that occurs during sport. However, if the damage is excessive and the remodeling cannot keep pace with the damage, then microscopic failures (fractures) occur. This Pars fracture is Spondylolysis.” [2]

So  [although it is only a very remote possibility],  IF Buchholz leaves a game with “back pain,” you will want to know, if it is musculoligamentous [strained muscles] or Spondylolysis [microscopic bone fractures], because the 45-day difference between a 15-day or 60-day stay on the DL may be the difference between the AL East pennant and a spine-tingling, one-game Wild Card back-breaker for Sox fans.

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[1] http://orthopedics.about.com/cs/sprainsstrains/a/lowback.htm
[2] http://www.physioroom.com/injuries/back/lower_back_stress_fracture_full.php

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