It is no longer simply a matter of “when” Clay Buchholz will come back from a back issue that has now had him on the disabled list for more than five weeks. Other questions are starting to creep into the equation, such as “if” and “in what capacity.”

Publicly, the Red Sox have pronounced their confidence in the return to health of their No. 3 starter. Multiple consultations with specialists were described as having offered peace of mind that a more significant injury wasn’t being risked. Lingering soreness in Buchholz’ lower back was described as simply a matter of pain management and tolerance, since the issue was viewed as being muscular rather than structural.

On Wednesday, however, another wrinkle emerged. While there had been some thought to having Buchholz (6-3, 3.48 ERA) throw his first full bullpen session of July prior to the Royals game, the Sox instead elected to delay the session until after the right-hander goes for another visit with a specialist about his back, on top of the two that he already has undergone.

The decision, manager Terry Francona suggested, was little more than a procedural formality based on the fact that the Sox are getting him ready to make significant strides forward.

“We want Buck to see one more specialist Friday, Monday-ish before we completely turn him loose just because, again, he’s starting to get aggressive,” said Francona. “With everything that has gone on in there, we just want to make sure this kid is OK.”

Buchholz has shown some physical improvement. He suggested on Monday, after throwing 30 pitches off a mound to a catcher who sat in front of home plate, that he was feeling 70-80 percent healthy – a sharp contrast to a side session in Philadelphia at the end of June in which he felt closer to 30 percent healthy.

Francona still referred to that session as “a really good day,” and team officials were encouraged by how the right-hander looked throwing the ball. That said, according to Francona, the team feels compelled to have Buchholz examined again by a specialist before having him shift into the most advanced stages of his rehab.

“His arm strength ... he looked two days ago like midseason form. That’s what was very encouraging to us,” said Francona. “At the same time, we’ve got an obligation to do the right thing.”

A source familiar with the matter suggested that it is more than obligation that is prompting this consultation. Instead, the source suggested that the Sox are “very concerned” that the issue is not muscular, but instead could involve a structural issue such as a bone.

The deliberate pace at which the right-hander has healed suggests that the issue could be something more than a muscle strain; perhaps the persistent back pain for Buchholz is a symptom of a larger problem. The Sox do not know that to be the case, and they won’t until after the right-hander goes for his next visit with a specialist.

Perhaps the visit will result in him getting cleared to proceed on the path of returning to games. But clearly, there is concern that the pitcher is dealing with something beyond a common muscle strain that would have permitted a steady pace of recovery.

The Sox have been afforded the luxury of a comfortable position in the standings (a 3.0 game lead over the Yankees in the AL East; an 8.5 game advantage over the Angels in the wild card) that allows them to take a deliberate route with the pitcher. And given that Buchholz is a centerpiece of the Sox’ competitive ambitions for years to come (his extension runs from 2012-15, with options for the 2016 and 2017 seasons), the feeling is that an extremely conservative course is the most sensible one in order to give the Sox the greatest likelihood of a healthy and effective Buchholz both down the stretch and in the future.

Under other circumstances, the Sox might have asked the 26-year-old to push through the injury and continue his rehab. But right now, there is little reason for the team to force the issue.

That said, the outlook for a return by Buchholz – already pushed back to mid- or late-August with this latest consultation – has become even more uncertain. Moreover, Buchholz is nearing a point that the idea that he will be able to return at full effectiveness can no longer be taken for granted.

And as the trade deadline gets closer, the Sox appear to be hedging their bets -- or, at the least, exploring the cost of doing so.

THE SOX GO TO MARKET

Even when the view of Buchholz was more optimistic, the Sox were kicking the tires on the starting pitching market, in part because it represents an area of potential upgrade this year, in part because it represents an area of potential upgrade beyond 2011.

When the name of Ubaldo Jimenez was first floated as a possibility a couple of weeks ago, it immediately snapped the Sox to attention. The Sox, according to WEEI.com’s Rob Bradford, remain engaged in talks with the Rockies about the right-hander.

But Jimenez hasn’t been the only pitcher whom the Sox have been scouting as a possible target. According to multiple major league sources, the team has been monitoring the starting pitching market more broadly for a few reasons.

--First, there is the uncertainty surrounding Buchholz – something that could be addressed either by a rental pitcher (someone under team contractual control just through 2011) or by a pitcher who is signed (or not yet eligible for free agency) through at least 2012.

--Secondly, there is the opportunity to improve upon the performances at the back end of the rotation this year.

John Lackey has shown promise, something that continued as he picked up his fourth win in as many starts on Wednesday, a span in which he has a 4-0 record, 2.52 ERA, 21 strikeouts and three walks in 25 innings. He is now 9-8 for the year.

However, Lackey’s strong run has essentially represented the alternation of two outstanding outings with two decent ones. While the big right-hander is certainly looking much better in recent outings than he did in the first half (his strikeout-to-walk ratio cannot be ignored), it still is hard to look past his 6.20 ERA when figuring out whether a rotation upgrade is possible.

For that matter, the ongoing struggles and/or inconsistencies of Andrew Miller (5.45 ERA, fewer than 5 innings per start) and Tim Wakefield (5.22 ERA) suggest that it makes sense for the Sox to explore whatever alternatives are out there.

That is particularly the case in light of Buchholz’ health. In a hypothetical scenario in which Buchholz was unavailable or limited in October, Lackey would go from a No. 4 postseason starter – someone who would most likely get no more than two starts, and who would have minimal influence over the Sox’ playoff fortunes – to the team’s No. 3, who would be in line for as many as five starts in the postseason.

If Lackey’s recent performances are indicative of his ability, then the Sox might not fret too much about that prospect.

“He’s been really consistent for the last while now,” said Francona. “The pitch count was kind of high, but he threw all his pitches, he threw his fastball by some people, he could elevate it at times, he threw his breaking ball for strikes. He’s pitching a lot more consistently.”

But, if Buchholz is limited and the first-half version of Lackey rears his head anew, then the Sox would be left with little grounds for optimism about a postseason No. 3. As a means of Buchholz/Lackey insurance, the team could elect to make a deal for either a short-term rental (Hiroki Kuroda, Erik Bedard, Rich Harden) or a player who would be under contractual control beyond 2011.

--Third, the trade deadline represents the best opportunity during the regular season to address needs for the following year. The Sox have an opportunity to investigate ways that they can improve their rotation not just for this year (when the playoffs are a near lock) but for the 2012 campaign, when the team has no set fifth starter behind the anticipated quartet of Beckett, Lester, Buchholz and Lackey.

The Sox prefer to avoid diving into the free-agent market for starters in the offseason. If the team isn’t sold on internal options such as Kyle Weiland or Felix Doubront (or Tim Wakefield, whom they could re-sign) for next year’s rotation, the trade deadline represents a rare opportunity to address a concern for next season. Such a move would spare the Sox a plunge into the expensive pursuit of CC Sabathia, C.J. Wilson or one of the other starters on the market.

THE OUTLOOK

Precedent suggests that all of these factors still might not be enough to create a deal. It is worth noting that the scenario unfolding for the 2011 Sox isn’t terribly far removed from the one that confronted the 2007 club at the trade deadline.

That team featured an ace (Beckett), a second starter who was performing well (Daisuke Matsuzaka), a veteran No. 3 on the disabled list (Curt Schilling) and a few question marks helming the back of the rotation (Tim Wakefield, Kason Gabbard, Julian Tavarez, Jon Lester).

That summer, the Sox ended up not making a deal. Instead, though they explored options such as a deal for Mark Buehrle of the White Sox, they got their upgrade with the return of Schilling, who ended up picking up three postseason wins and serving a key role in the Sox’ run to a title.

Whether that pattern can be repeated in 2011 remains to be seen. However, with just three days looming until the trade deadline, it is clear that the Sox are exploring their options.

That is not a guarantee of a deal. Far from it. As one team source pointed out, while the Sox are always looking to improve their roster, the club will also consider carefully the acquisition cost of an upgrade.

“We value our prospects,” said the source. 


But the team also values the opportunity at hand with a club whose title ambitions are legitimate. And while standing pat is an option, particularly if Buchholz receives another positive prognosis, the team’s motivation to investigate the possibility of rotation reinforcements is clear.