Yips

The yips are involuntary wrist spasms that occur most commonly when golfers are trying to putt. However, the yips also can affect people who play other sports — such as cricket, darts and baseball.

It was once thought that the yips were always associated with performance anxiety. However, it now appears that some people have the yips due to a neurological condition affecting specific muscles. This condition is known as focal dystonia.

Changing the way you perform the affected task might help you find relief from the yips. For example, a right-handed golfer might try putting left-handed.

The most common symptom associated with the yips is an involuntary muscle jerk, although some people experience tremors, twitches, spasms or freezing.

In some people, the yips are a type of focal dystonia, a condition that 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. Anxiety worsens the effect.

Some athletes become so anxious and self-focused — overthinking to the point of distraction — that their ability to perform a skill, such as putting, is impaired. "Choking" is an extreme form of performance anxiety that may have a harmful effect on a golfer's or any athlete's game.

The yips tend to be associated with:

• Older age.
• More experience playing golf.
• Tournament play.

There is no standard test to diagnose the yips. A neurologic exam may be performed to rule out other potential causes. Diagnosis of the yips is based on people describing their symptoms. Video recording the wrist during putting to capture the movement associated with the yips also can help the healthcare professional make the diagnosis.

Because the yips may be related to overuse of specific muscles, a change of technique or equipment may help. Consider these strategies:

• Change your grip. This technique works for many golfers, because it changes the muscles they use to make the putting stroke.
• 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 that might help are designed with a special grip to stabilize the hands and wrists.
• Look at the hole while putting. Changing your head position and where your eyes focus may help. Try looking at the hole when you putt instead of down at the ball.
• Mental skills training. Techniques such as relaxation, visualization or positive thinking can help reduce anxiety, increase concentration and ease fear of the yips.
• Medicines. Treatment with medicines taken by mouth may help manage the yips. Benzodiazepines, baclofen and anticholinergic drugs can be used to treat focal dystonia, and propranolol can be used to treat tremor.
• Botulinum toxin injection. A careful shot of botulinum toxin, such as onabotulinumtoxinA (Botox), incobotulinumtoxinA (Xeomin), abobotulinumtoxinA (Dysport) or botulinum toxin type B (Myobloc), into the muscles that are overacting can be used to treat focal dystonia. This can help limit muscle contractions and may calm the yips.

Before taking medicine to treat the yips, check with your sport's governing bodies if you compete professionally or in sanctioned amateur events. Rules regarding banned substances differ from sport to sport and organization to organization.

While you may initially consult your primary care team, they may refer you to a healthcare professional who specializes in sports medicine.

What you can do

You may want to write a list that includes:

• Detailed descriptions of your symptoms.
• Information about any medical problems you've had.
• Information about the medical problems of your parents or siblings.
• All the medicines and dietary supplements you take.
• Questions you want to ask the healthcare team.

For yips, some questions to ask your healthcare team may include:

• What might be causing my symptoms?
• Is there any treatment for my symptoms?
• Will I always be affected by the yips?
• Do you have any brochures or printed material I can take with me? What websites do you recommend for information?

What to expect from your doctor

Your healthcare professional may ask detailed questions about how and when your symptoms occur. They also may want to observe your putting stroke. But because the yips occur most often under tournament conditions, it may be impossible to demonstrate the yips on command.

Questions your healthcare professional may have for you include:

• When do your symptoms usually occur?
• How long have you been experiencing symptoms?
• Do your symptoms occur with any other activities?
• What, if anything, seems to make your symptoms better?
• Does anything seem to make your symptoms worse?