The Washington Nationals are not afraid of Tommy John surgery recipients

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Two things are constants on the Nationals roster: Scott Boras clients and Tommy John surgery recipients.

Recently adding reliever Trevor Rosenthal checked both boxes, a rare two-fer for Mike Rizzo and his staff. Rosenthal joins Stephen Strasburg and Erick Fedde as the other Boras clients who went through Tommy John surgery and wears the Nationals uniform. The new setup man also hops on a long list surgery recipients to land on the Nationals roster. Rather than the surgery scaring the organization, it seemingly emboldens them.

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Dial back to May 23 of last season. Fedde, whom the Nationals selected in the first round of the 2014 MLB draft despite knowing he would need Tommy John surgery, started. Tim Collins, returning from his second Tommy John surgery, relieved him. Sammy Solis, recipient of Tommy John surgery in 2012, entered an inning later. Shawn Kelley, with two Tommy John surgeries, finished the game. The Nationals used five pitchers that day. Only one, Trevor Gott, had not been to a surgeon to have his ulnar collateral ligament fixed. The rest combined for six surgeries.

Elias did not weigh-in on whether six total surgeries showing up in one nine inning game equaled a record. But dispatching that many previously injured pitchers, like signing Rosenthal, reaffirmed the organization's belief in how it can handle the recovery process.

"We've done this song and dance before," Rizzo said late in the season. "We're pretty adept at rehabilitations of Tommy John."

This time, Rizzo was addressing the surgery needed by 2017 first-round pick, and left-handed starter, Seth Romero. Dr. Neal ElAttrache, who is evolving into the new Dr. James Andrews, performed Romero's surgery. He also fixed Rosenthal, putting the Nationals' newest reliever on the so-common path in their clubhouse.

Surgery is followed by stagnation. It's easier to wait at the start. But, progressively, it becomes harder. Most pitchers come out of the rehabilitation process in better shape from head-to-toe. The arm needs rest to recover. The remaining parts of the body can be worked as necessary. Joe Ross, for instance, returned to the Nationals last season a more muscular version of himself because of Tommy John surgery. He also went through the same daunting experience of throwing a baseball for the first time once cleared by doctors and therapists.

"I had been itching to throw for a little bit," Ross said this summer. "Just doing all the PT every morning, stuff like that. When the time comes, it's like tick, tick, tick [raising arm], is it going to boom or is it going to be OK? But it was all right. Ever since then I've been feeling pretty good."

Ross pulled the first throw wide of his target. Former Nationals reliever Greg Holland threw his first post-surgery toss into the ground. Twice. He eventually righted himself.

Rosenthal contends the process has been near-seamless for him. So much so, that he considered pitching in September of last season. Discussions with his medical team and agents convinced him to wait. They believed an early offseason showcase that allowed him to throw 99 mph in front of team representatives would be plenty to secure a contract. It was for the Nationals.

"I think the biggest thing up front is I tell them this is a trial in patience more than anything," Keith Sanders, a physical therapist at Barnes-Jewish West County Hospital who worked with Rosenthal, said. "This isn't the more effort you put in, the better the outcome. A lot of these guys already have the effort level. It's a lot of the reason why they're at the big league level. I really almost kind of try to put the reins on them up front and tell them the biology has to take place."

Once Rosenthal was cleared to throw, he was still restricted. His arm felt the best it had in 6-7 years, by his estimation. The people in charge of his recovery told him he was allowed to throw from 40 feet. And not a lot. Then he had to stop.

"I was like: ‘Really? That's it?' I'm used to throwing really hard for an extended amount of time every single day," Rosenthal said. "It seemed like it wasn't enough work. And it took a few months to get to a point where I was happy with the amount I was allowed to throw, just the protocol of the program. So I don't really have too many silly stories. Everything just went so well, and my arm felt so good through the whole process, I've just been excited. It was later in this year, over the last few months, where I could finally start just throwing normal with no restrictions."

Done with the strength people, physical therapist and ElAttrache, Rosenthal moves into the hands of the Nationals. The organization made significant changes to its medical personnel in 2015, taking the unusual step of holding a press conference to tout the alterations in staff and approach. Rosenthal was intrigued by his first meeting with the group.

"Just being in D.C. last week for my medical evaluation, getting to meet the medical staff, they seemed really ahead of the curve and had some things they were talking to me about or testing me on that I had never seen before," Rosenthal said. "So I am really looking forward to being involved in that and hopefully the progression will help me with the surgery and the recovery."

As Rizzo said, they've been through this before.


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