LINKEDINCOMMENTMORE

Kansas City, Mo.— He was taking some swings in the cage Friday when the symptoms returned — as they had during Thursday's off-day workout.

For Alex Avila, that meant dizziness, lightheadedness, the difficulty to focus — conditions that can be traced not only to the last foul ball he took off his mask, but to a jarring tag to the head at first base in Sunday's game at home against Cleveland.

So for the fourth game in a row Friday night, Avila wasn't in the Tigers' starting lineup. Starting just his second major-league game, rookie James McCann took his place. McCann got his first Major League hit in the fourth inning.

For the first time, though, manager Brad Ausmus indicated just how uncertain Avila's return to the lineup is — so much so that the Tigers have to be prepared to move on without him.

"There's no positive news in regards to Alex today," Ausmus said — replying "yes" to the question of whether it's becoming more concerning every day.

Soon after McCann joined the Tigers as a September call-up, Ausmus said he probably wouldn't catch much — because "it wouldn't be fair to him or to the pitchers."

On Friday, though, Ausmus said "the truth is that if we don't know when Alex is coming back, you have to be prepared.

"If he doesn't come back, we're going to need two catchers. But until Alex can go through any activity, he probably won't be able to play."

That's the first reference to the possibility of Avila not being able to return this season from his disorienting condition.

But the Tigers are naturally hoping he can — and will.

"If he has one side session and comes back the next day with no symptoms," Ausmus said, "and can go through batting practice that day, he might be able to play."

Providing an update of how he's feeling, Avila said, "I haven't had any headaches, but I'm still trying to get through a day of baseball activity without any symptoms.

"If there was any indication I was ready to go, I'd be playing already. But I've been trying to recover since coming out of that game on Sunday.

"I'm fine, like when I wake up in the morning, and I sleep well. I've had no issues like that. But going from having no symptoms just sitting on my butt, to going back to activity, I get to a certain point where I start feeling dizzy again."

Asked if he feels angry, frustrated or worried when the symptoms return, Avila said "a little of all those things. Absolutely.

"But probably more frustrated than anything."

The symptoms, of course, are concussion-like symptoms. It's been long acknowledged that Avila takes more foul balls off his mask than most catchers — meaning that, bottom line, he takes a pounding behind the plate.

A hard tag to the head didn't help.

"As bad as I'd like to say I'm fine," he said, "I can't do that until I'm actually fine. But my concussion last year was pretty similar.

"This concussion wasn't any worse than last year's. Actually where I'm at now, it took me 10 to 12 days for me to get to, so I'm actually farther along than last year in terms of recovery. But you have to let it heal before you can play again.

"The concern would be is if you play while concussed and get hit again. That's where damage could occur."

Avila said he feels disoriented when "a ball is thrown to me. At some point, I have to step back because I have trouble focusing.

"That's what has set me back the last few days."

And the tag to the head proves it's not just a foul off the mask that can prove harmful.

"I took a foul ball earlier and I was fine," Avila said. "I know a lot has always been made about the foul balls I take, and I've made peace with that. It's nothing that bothers me when I go into a game.

"But it's probably a good thing this happened on a tag to the face. I mean, how often is that going to happen?

"It's one thing to play, though, when you may not feel 100 percent. It's another thing to play when you're just not mentally right."

So Avila waits to get to get better. But he can only watch while he does.

tom.gage@detroitnews.com

twitter.com/Tom_Gage

LINKEDINCOMMENTMORE