I think he's been hurt since May of last year and still isn't healthy. The team expected him to come back earlier than he did last season, and when he did come back, he didn't pitch deep into games and didn't have his normal stuff. This year of course has been a disaster. He can't throw the ball with any command at all, except for a few short stretches.
Back in June, he talked about pitching through pain last year:
“Last year, I had to figure out a way to throw that I didn’t feel altered in any way, that I didn’t feel anything hurting,” Buchholz told reporters in Detroit following Sunday’s sim game. “I’m sure a couple of things in my delivery changed last year without even trying. Just human nature, if something hurts, you try to do it differently. I’m sure that followed me into spring training this year. It just took me a little longer to do it than I wanted to.”
This is an interesting blog from last July:
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What Buchholz is going through right now probably doesn't mean he can't pitch. It may very well mean he can't be the pitcher that we all want him to be.
Cafardo correctly mentions that Buchholz has said that, if this were September, he'd pitch."
He did come back and pitch in time for the playoffs, but he got through that shortened World Series start on smoke and mirrors.
My guess is that last year the team was pushing him to pitch through pain, and he didn't want to, but finally did in September and the playoffs. And he might still be doing that this season, only instead of giving us a few effective innings in a huge game, he is basically John Lackey in 2011-- not that he has the same injury Lackey did, but that he isn't healthy but is going out there and pitching anyway because he is not so hurt that he can't pitch, just so hurt that he can't pitch effectively.
