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Yips

Definition:
Imagine yourself out on the golf course on a beautiful summer afternoon. You hit your best tee shot of the day, the second sails straight down the fairway, and your approach shot lands three feet from the cup. Just one smooth tap of the putter and you'll card a birdie.

You feel confident as you address the ball. But just as your putter is about to make contact with it, a hand and wrist spasm interrupts your calculated stroke — and your ball rolls past the cup.

You've just experienced the yips.

In up to 25 percent of serious golfers, the yips causes sudden, involuntary tremors, jerks or freezing in the hands and wrists that interrupts a putting stroke. To a casual observer, the yips might seem like a psychological issue — choking on a key putt. However, research has shown that sometimes there's more to it than that. Some cases of yips are related to a neurological dysfunction affecting specific muscles, called a focal dystonia.

Whatever the cause, the yips can add five strokes or more to an 18-hole game — making it a frustrating problem for affected golfers.

Causes:
To someone without the yips, the problem can seem purely psychological, but researchers have found that it's more accurate to divide yips-affected golfers into two categories. Type I yips is related to the neurological disorder of dystonia, and type II yips is caused by choking, a psychological response to high anxiety in a pressure situation.
  • Type I (dystonia). Golfers with type I yips have a neurological disorder called focal dystonia, which causes involuntary muscle contractions during a specific task. It's most likely related to overuse of a certain set of muscles, similar to writer's cramp. Golfers adopt an abnormal posture when gripping a golf club, and repeat the same fine muscle movements for years. The repeated posture places stress on the muscle and may eventually contribute to development of the neurological disorder.

    Dystonia doesn't just affect golfers. Task-specific cramps can develop in anyone who performs repeated fine muscle movements in an abnormal posture, like other athletes, dentists, musicians and stenographers.

    Anxiety makes all movement disorders, such as tremors and tics, temporarily worse. Type I yips symptoms tend to increase during tournaments — especially when the golfer is in the lead — or in other situations requiring intense coordination and concentration. Type II yips, on the other hand, is actually caused by anxiety.

  • Type II (choking). In a pressure situation, some athletes become so anxious and self-focused — overthinking to the point of distraction — that their ability to execute a skill, like putting, is impaired. Choking is an extreme form of performance anxiety that may compromise a golfer's game, and for some, it can trigger the yips.

In an earlier study, researchers observed several differences between golfers with the yips and unaffected golfers. Those with the yips tend to have higher heart rates, a tighter grip on the putter, and increased forearm and wrist muscle activity as measured with electromyography (EMG). These changes seem to be related to the jerking, freezing and tremors experienced by golfers with the yips.

Risk Factor:
As a risk factor for developing type I yips — the type related to a neurological dysfunction — experience works against you. The yips most commonly affects serious golfers who have played for more than 25 years. Specifically, type I yips is associated with:
  • Older age
  • More than 20 years playing golf
  • Lower handicap

These risk factors don't apply to the form of yips related to performance anxiety, however. Type II yips, or choking, can be acquired at any age and experience level. When you start to have episodes of the yips, you lose confidence, worry about recurrence and feel anxious whenever you have to putt. These reactions can perpetuate the cycle — your increased yips-related anxiety makes your yips symptoms worse.

When to seek medical advice:
If you are experiencing jerks, tremors or freezing during your golf game, especially during key putts, you may have the yips. There are strategies for dealing with both type I and type II yips. Consultation with a sports-focused physician, psychologist, physical therapist or putting coach knowledgeable in type I and type II yips may help you get back on the course.

Symptoms:

Golfers can experience the yips in different ways. The yips may occur as you address the ball to take your stroke — just as you're ready to draw the club back to begin the putt, you begin to shake or simply freeze in place. Getting your muscles to "snap out of it" can disrupt your planned stroke. Other times, your wrist or hand may suddenly jerk in the middle of your stroke, sending the ball off course.

The yips tends to come and go, and is less likely to occur during longer shots like drives. The problem is most pronounced during putting, particularly on short, fast or downhill putts — although some golfers experience symptoms during chipping as well. Anxiety can make the yips worse, so while yips may crop up only occasionally during practice, it happens more often during competitive play — and it's often worst in high-pressure situations, like when you're leading a tournament.

Diagnosis:
Most specialists will diagnose the yips based on your self-reported signs and symptoms. To determine whether your yips are related to focal dystonia or choking, the specialist may ask you some detailed questions about how and when your symptoms occur. You also may be asked to demonstrate your putting stroke so that the specialist can observe your symptoms directly. However, since the yips is episodic and occurs most often under tournament conditions, it may not be possible to demonstrate your symptoms on command.

A more detailed evaluation also may include a swing analysis, where the biomechanics of your swing or putting stroke are recorded and evaluated.

Complications:
While it's certainly not life-threatening, the yips can cause real distress. Even if you've been an avid golfer for years, developing the yips can take all the fun out of your game. Because experienced, dedicated golfers are often the ones who get the yips, the effects on physical and psychological health can be serious. If golf is your main form of exercise, avoiding the fairway can lead to a decline in your overall fitness. Stress may be harder to cope with, and your social interaction — which is crucial to staying healthy — may diminish. These changes may increase your risk of depression.

Treatment:
Currently, there is no cure for the yips — once you have it, it's not likely that the yips will resolve on its own. However, there are strategies for reducing the impact of both types of the yips.

Because type I yips may be related to overuse of specific muscles, a change of technique or equipment may help.

Possible strategies include:

Change your grip
This technique works for many golfers, because it changes the muscles you use to make your putting stroke. However, if you have the type of yips related to performance anxiety, changing your grip likely won't make much difference.

Use a different putter
A longer putter allows you to use more of your arms and shoulders and less of your hands and wrists while putting. Other putters are designed with a special grip to help stabilize the hands and wrists.

Mental skills training
Techniques such as relaxation, visualization or positive thinking can help reduce anxiety, increase concentration and ease fear of the yips. Because stress can cause type II yips and make type I yips worse, getting your anxiety under control may help reduce yips episodes.

Emerging therapies
Botulinum toxin (Botox), dopamine agents and beta blockers have been proposed as treatments for the yips, but more research needs to be conducted before any of these are proven treatment options. None of these therapies has demonstrated lasting effectiveness.

 
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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