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Yips

Introduction
Signs and symptoms
Causes
Risk Factors
Screening and diagnosis
Treatment

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.

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.

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.

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.

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.