A motor phenomenon affecting golfers, the yips consist of involuntary movements during the performance of shots requiring fine motor control, such as chipping and putting. Although the yips are mainly reported by golfers, the psychological characteristics of a small group of cricket bowlers who experience yips-like symptoms have also been reported, suggesting the condition is generalizable beyond golf. Generally, the yips are characterized by excessive, involuntary muscle activity, resulting in unwanted movement, or an inability to initiate movement. In the past decade, the definition of the yips has expanded to encompass an etiological continuum, anchored by two subtypes, with a neurological basis (focal dystonia) at one end and a psychological basis (performance anxiety) at the other. Subtypes can be defined by identifying themes in golfers’ descriptions of their experiences. Those with descriptions of dystonia can be classified as Type I yips, while those whose descriptions include performance anxiety or choking theme can be classified as having Type II yips. Type I yips have many characteristics in common with other forms of focal dystonia. The aim of this entry is to encourage the use of the term yips only for those with a task-specific focal dystonia. The intention is that a more consistent terminology will clarify appropriate management strategies of those with a true dystonia (the yips) versus those who suffer symptoms of performance anxiety.
The symptoms of upper-limb focal dystonias are dominated by involuntary contractions of the hand and forearm musculature that result in awkward, uncoordinated movements of the wrist, fingers, or both. These symptoms are due to the inappropriate cocontraction of antagonists and agonists, which is often associated with excessive levels of muscle activity. Symptoms are triggered by the repetitive performance of a skilled motor task over months or years, such as writing, playing a musical instrument, or putting a golf ball. Multiple lines of investigation support the hypothesis that focal dystonias are associated with impaired inhibitory function at multiple levels of the central nervous system, which may stem from basal ganglia dysfunction. Cathy Stinear et al. showed that low-handicap golfers with experiences of Type I versus Type II yips could be dissociated by their electromyography activity in muscles of the putting arm under low-stress conditions, as well as by their performance on a computer-based response inhibition task. In both cases, Type I yips golfers showed excessive electromyographic activity compared to Type II, and to matched controls. Similarly, through the use of an instrumented kinematic glove, Charles Adler et al. observed that yips-affected golfers had excessive involuntary pronation–supination of the forearm.
Like other forms of focal dystonia, golfers with the yips may opt to retrain themselves to perform the task differently, given that no effective rehabilitation strategy has yet been developed. The symptoms of focal hand dystonia and Type I yips can sometimes be temporarily alleviated by the use of sensory tricks, such as wearing a glove on the affected hand, using a different grip, or by changing to a different (usually longer) putter. The management of yips could draw from the treatments used for occupational dystonias, such as writer’s cramp and musician’s cramp. A range of therapeutic strategies have been trialled for these types of dystonia, including immobilization of the affected hand or upper limb, often combined with ergonomic changes, motor training, and sensory training. Unfortunately, these types of interventions have produced mixed results for writer’s cramp and musician’s cramp and would require a considerable time commitment from the golfer, under the guidance of a trained physical therapist.
If the overactive forearm muscles can be clearly identified in an individual, injection of botulinum toxin can markedly reduce the level of involuntary activity. However, this treatment carries the risk of the toxin spreading to adjacent musculature not intended for treatment, and the effects of treatment are temporary, lasting approximately 3 to 4 months. Interestingly, an isolated case of improvement in yips symptoms during golf was reported by a patient undergoing memantine administration for treatment of Alzheimer’s disease, but a systematic trial has yet to be conducted.
Many studies of the yips have used questionnaires to explore the symptoms, clinical history, and sport experience of the participants. For the sport psychologist, it is interesting to note that golfers who experience performance anxiety exhibit yips-like symptoms when they experience choking, where severe performance anxiety impairs the preparation and execution of movement, degrading performance. A model proposed by Aynsley Smith et al. was developed on the basis of questionnaires completed by 70 golfers who experience yips symptoms. One of the limitations of this study is a potential response bias, as only 39% of invited participants (both with and without yips symptoms) completed and returned the questionnaires. A further limitation is that the respondents’ descriptions of their symptoms are subjective, and therefore may not accurately describe the range of physical manifestations of the yips. Still, this model is effective for differentiating patients with focal dystonia from those with performance anxiety, thus reflecting an important advance. Generally, the combination of distraction by the specific competitive context and an increase in arousal and self-awareness, increases performance anxiety and decreases confidence, which in turn increases the likelihood of suboptimal performance. The most anxiety-provoking situations for affected golfers include (1) leading the competition, (2) tricky putts (those putts with more than one change in inclination), (3) playing against specific competitors, and (4) the need to make easy putts. Most researchers and clinicians are in agreement that yips-like symptoms are exacerbated by heightened anxiety. However, it should be reinforced there is considerable debate concerning whether excessive anxiety is sufficient to trigger actual yips symptoms.
- Adler, C. H., Crews, D., Kahol, K., Santello, M., Noble, B., Hentz, J. G., et al. (2011). Are the yips a task-specific dystonia or “golfer’s cramp”? Movement Disorders, 26, 1993–1996.
- McDaniel, K. D., Cummings, J. L., & Shain, S. (1989). The “yips”: A focal dystonia of golfers. Neurology, 39, 192–195.
- Smith, A. M., Adler, C. H., Crews, D., Wharen, R. E., Laskowski, E. R., Barnes, K., et al. (2003). The “yips” in golf: A continuum between a focal dystonia and choking. Sports Medicine, 33, 13–31.
- Stinear, C. M., Coxon, J. P., Fleming, M. K., Lim, V. K., Prapavessis, H., & Byblow, W. D. (2006). The yips in golf: Multimodal evidence for two subtypes. Medicine & Science in Sports & Exercise, 38, 1980–1989.