Yips

The yips are sudden, uncontrolled movements of the wrist or hand. They most often happen when golfers are putting. But the yips can affect people who play other sports, such as cricket, darts and baseball.

In the past, researchers thought that yips were caused by performance anxiety. Researchers now know that, for some people, the yips are caused by a condition in the nervous system that affects certain muscles. This condition is called focal dystonia.

Changing how you perform the affected activity may help reduce symptoms. For example, a golfer might change their grip or use a different putter.

The most common symptom of the yips is a sudden muscle jerk. Some people also may have shaking and twitching. And muscle spasms or brief freezing of movement also are symptoms of the yips.

For some people, the yips are caused by focal dystonia. This is a condition that causes muscles to contract without control during a specific activity. It most likely is linked to overuse of certain muscles, similar to writer's cramp. Anxiety can make the symptoms worse.

For other people, the yips are related to performance anxiety. They may become overly anxious or focus too much on their movements. This can interfere with their ability to perform a skill, such as putting. Choking is an extreme form of performance anxiety that can negatively affect performance in golf and other sports.

The yips are not usually inherited. In some cases, a genetic tendency may affect how the brain controls movement. This can make symptoms more likely after years of repetitive practice or under stress.

The yips are more common in people who:

• Are older.
• Have played golf for many years.
• Play in tournaments.

There is no single test for diagnosing the yips. A neurological exam may be done to rule out other possible causes.

Diagnosis typically is based on a person's description of the symptoms. Video recordings of the wrist during the activity may help confirm the diagnosis.

Because the yips may be related to overuse of certain muscles, changing your technique or equipment may help. The following strategies may reduce symptoms.

For golfers:

• Change your grip. This helps many golfers because it changes which muscles are used during 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. Some putters also have special grips that help 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 instead of the ball when you putt.

For other athletes:

• Change how you perform the task. Adjusting your hand position, posture, or body movement may reduce symptoms by using different muscles.
• Use different equipment or tools. Changing the size, weight or grip of the bat, dart or other equipment may help improve control.
• Switch hands or change roles when possible. Using your non-dominant hand or changing how you approach the task may reduce muscle strain.
• Slow down your movement. Moving more slowly and deliberately can help reduce sudden muscle spasms or jerking.

For everyone:

• Practice in a low-pressure setting. Symptoms often worsen under stress. Practicing without time limits, scoring, or an audience may help.
• Work with a specialist. Physical therapists, occupational therapists or sports medicine professionals can help retrain movement patterns and reduce overuse.
• Use mental skills training. Relaxation techniques, breathing exercises and visualization can help reduce anxiety and improve focus during performance.
• Medicines. Some medicines that you take by mouth may help manage the yips. Some are used to treat focal dystonia, while others may help reduce tremor.
• Botulinum toxin injections. In some cases, carefully placed injections of botulinum toxin (Botox, Xeomin, others) into overactive muscles may help. These injections can reduce muscle contractions and may calm the yips. But most people with yips do not need this treatment.

If you compete in professional or sanctioned amateur sports, check with your sport's governing body before taking any medicine. Rules about banned substances vary by sport and organization.

You may first see your primary care team. Your team may refer you to a healthcare professional who specializes in sports medicine.

What you can do

Before your appointment, it may help to make a list that includes:

• A detailed description of your symptoms.
• Any medical conditions you have had.
• Medical conditions that run in your family.
• All medicines and dietary supplements you take.
• Questions you want to ask.

Questions you may want to ask include:

• What might be causing my symptoms?
• What treatments are available?
• Will the yips go away?
• Are there brochures or printed materials I can take home?
• What websites do you recommend for more information?

What to expect from your doctor

Your healthcare professional may ask detailed questions about your symptoms, when they happen and what they feel like. You may be asked to show the movement that triggers your symptoms.

Because the yips often occur during competition or high-pressure situations, it may not be possible to reproduce the symptoms during an office visit.

Questions your healthcare professional may have for you include:

• When do your symptoms usually occur?
• How long have you had these symptoms?
• Do the symptoms happen during other activities?
• What seems to make your symptoms better?
• What seems to make your symptoms worse?