The breaking ball is a devastating weapon in a Little League baseball game. To even the best players, the pitch is nearly unhittable. Unfortunately, the pitch's nasty effect goes beyond baffling opposing hitters.

Among pitchers under 12 years old, nearly 45 percent complain of chronic elbow pain. According to a study published by the The Journal of the American Academy of Orthopaedic Surgeons (AAOS), overuse and incorrect throwing mechanics are the primary causes of elbow injuries in young pitchers.

"In youth baseball, there are certain motions that are repeated over and over again which are likely to create an overuse injury," says Dr. Bernard R Bach, Jr., Director of Sports Medicine at Midwest Orthopaedics at Rush. "Even in a normal throwing motion, the elbow is under a tremendous amount of stress. Factor in abnormal mechanics, such as the motion used to throw a breaking ball, and the stress is multiplied."

Boys are often able to learn the curveball at age 10 or 11 years of age, which is, according to Dr. Bach, well before their arms are ready for the strain. Competitive coaches encourage their pitchers to throw breaking balls, and also exhibit a tendency to overuse their better hurlers.

Patrick McKune, treasurer of Oak Park Youth Baseball, has witnessed the trend of injury and overuse. "In the Little League World Series, it was reported that 60-65% of the pitches thrown are curveballs," says McKune. "You just have to shake your head. Another wakeup call for me was last year when I witnessed my son throw six straight curveballs in a game."

Disturbed by this growing trend, McKune decided to take action. Along with Dr. Bach and representatives from Athletico, McKune arranged a meeting with the Oak Park Youth Baseball board, making the case for a ban on breaking balls combined with a mandatory pitch count. The board agreed with Bach's medical opinion and enacted both the ban on breaking balls and pitch count restrictions. Dr. Bach is confident that it will have a dramatic effect on the occurrence of injury.

"I've performed elbow surgery on 12 and 13 year old pitchers, and it's just heartbreaking," says Bach. "These overuse and stress-related problems can affect growing parts of the bone (the "growth plates"), not just muscles, tendons, and ligaments. When the condition is not treated, it can cause long term problems." Bach added, "It seems that every parent thinks there kid is on the fast track to a division I scholarship, and ultimately a professional baseball career. There is a "graveyard" of talented kids whose careers ended prematurely because of throwing related elbow and or shoulder injuries. We advocate throwing a fastball and a change up, but no curve balls until approximately 13-14 years of age. The kids should focus on pitching mechanics and control. Kids mature at different rates and mechanics can change dramatically when adolescents go through rapid growth spurts which may result in significant muscle imbalances."

McKune initially thought that enforcement of the new rules may be an issue, but to date no infractions have been observed. To his knowledge, the ban enacted by Oak Park Youth Baseball may be unique to the area. "It's my hope that other leagues will adopt similar rules to protect the health of their young players."

For more information on youth baseball safety, consult the Prevention and Emergency Management of Youth Baseball and Softball Injuries. This guide can be downloaded from the American Orthopedic Society for Sports Medicine site, www.aossm.org, or indirectly through Dr. Bach's website, www.bachmd.com. For more information on Dr. Bach, call 877 MD BONES.