The Yips: A Focal, Task-Specific Dystonia or Golfer's Cramp
Charles H. Adler, M.D., Ph.D., Mayo Clinic in Arizona
John N. Caviness, M.D., Mayo Clinic in Arizona; Debra J. Crews, Ph.D., Arizona State University; Troy L. McDaniel, Ph.D., Arizona State University
Using multiple quantitative methods Dr. Adler and his team are trying to determine whether some golfers with the yips have a focal, task-specific dystonia called golfer's cramp.
Background and rationale
Dystonia affecting athletes has received little research attention, and there has been a lack of awareness or interest among both physicians and athletes. As dystonia and occupational cramps affect people who write, type, and play musical instruments, it is logical to believe that dystonia also affects people who play sports. Golfers all know about the "yips," a term used to describe golfers who miss key putts in tournaments. It is estimated that up to 30% of golfers with years of experience and moderately low handicaps develop the yips.
This syndrome is characterized by an inability to appropriately complete a golf stroke, most often putting and chipping strokes. Most individuals with the yips describe a jerking or shaking movement that interrupts their swing. In many cases, the yips are disabling and the golfers, including professional tour players, give up golfing. The cause of yips is poorly understood and scientific study of the yips has been minimal. The research group led by Dr. Adler has published a number of articles on this topic.
We first studied 20 male golfers (10 yips-affected and 10 age- and handicap-matched golfers who did not complain of the yips) in a laboratory setting. Utilizing surface EMG recordings while the golfers putted, we found that 200 milliseconds prior to impact of the putter with the ball there was co-contraction of wrist flexor and extensor muscles in 5/10 of the yips-affected golfers but in 0/10 of the yips-unaffected golfers (p=.06, exact McNemar test). These data suggest that some yips-affected golfers have a focal dystonia.
A second study on an outdoor putting green also used surface EMG as well as CyberGlove II technology to monitor hand and wrist movements. In that study of 17 golfers who had the yips and 33 who did not, 7/17 (41%) golfers with the yips had co-contraction while 6/33 (18%) of those without the yips had co-contraction (p=0.08). Additionally, we found that the golfers with the yips had more rotation of the right wrist when putting.
Most recently, we studied 27 golfers, five who appeared to have a dystonia or golfer's cramp, nine who had yips that did not look like a dystonia, and 13 who did not have any yips during the study period. We studied two-handed putting as well as putting with the right hand only. We found more wrist acceleration and variability in wrist movement in those with golfer's cramp. We also found more yipped putts as well as more yipped putts with co-contraction in the group with dystonic golfer's cramp. That group had the same number of putts with the yips and with the yips + co-contraction using both hands or right hand only, whereas the golfers that had the yips but it did not appear to be dystonic had few yips with co-contraction with two-handed putts but a big increase with right hand only.
The etiology for the yips, and for all task-specific dystonias, remains unclear and still requires further study. The primary treatment for task-specific dystonias is botulinum toxin. While treating the yips has predominantly been by changing putter, changing how the golfer holds the putter or changing the grip on the putter (much like is tried with writer's cramp), there have been no studies of botulinum toxin injections for treatment of the yips. It is important to try to determine whether the yips is due to a neurological cause or a psychological cause as treatment will definitely differ. Dr. Adler's group continues to work on this.
- Adler CH, Crews D, Hentz JG, Smith AM, Caviness JN. Abnormal co-contraction in yips-affected but not unaffected golfers: Evidence for focal dystonia. Neurology. 2005;64:1813.
- Adler CH, Crews D, Kahol K, Santello M, Noble B, Hentz JG, Caviness JN. Are the yips a task-specific dystonia or "golfer's cramp"? Movement Disorders. 2011;26:1993.
- Adler CH, Temkit M, Crews D, McDaniel T, Tucker J, Hentz JG, Marquardt C, Abraham D, Caviness JN. The Yips: Methods to Identify Golfers With a Dystonic Etiology/Golfer's Cramp. Medicine and Science in Sports and Exercise. 2018;50:2226.