Yips Focal Dystonia May Affect More Athletes Than Previously Recognized

Daniel M. Keller, PhD

October 02, 2019

NICE, France — Yips, a focal task–specific dystonia, may be more prevalent than previously thought, according to a new study of golfers. It may run as high as 5.7% in this population, and although it is most evident during putting, it can affect other golf swings as well.

Lead investigator Erik van Wensen, a neurologist practicing in the Netherlands, said little has been known about the prevalence of yips and the factors that precipitate it. He himself has yips and demonstrated its effect to observers on a poster tour here at the International Congress of Parkinson's Disease and Movement Disorders (MDS) 2019.

While putting with his right hand, he experienced a sudden jerk in the wrist/forearm, which caused him to miss the target.

He said that the condition affects people in other sports as well, including cricket bowlers, baseball players, snooker players, and darts players. Other terms by which it is known include twitches, staggers, jitters, and jerks. It involves sudden, involuntary movements at crucial moments. Yips has caused many amateur and professional players of various sports and pastimes to abandon those activities, including van Wensen himself, who gave up golf.

To investigate the prevalence of yips and the risk factors for it, he and his colleagues conducted a Web-based study among all members of the Rosendaelsche Golf Club, a large Dutch golf club that dates to the late 19th century.

They approached all 912 members of the club via mail and the club's homepage, asking them to anonymously complete a Web-based questionnaire. The questionnaire asked about age, the player's sex, golf handicap, dominant hand, years playing golf, onset and duration of yips, when yips occurs (during putting, chipping, or using irons or a driver), which side was affected, smoking, and alcohol use. A visual analogue scale was used to assess fanaticism regarding sports, golf, and competition. The questionnaire also asked about the presence of possible obsessive-compulsive traits, current medications, medical history, family history of neurologic diseases, and whether the participant had any first-degree relatives with yips. It also asked the participants to complete a dystonia screening questionnaire.

Of the 912 invitations to participate in the survey that were sent out, 234 (25.6%) golfers accepted. Of the respondents, 52 (22.2%) indicated that they had yips.

"Men have probably a higher risk of getting the yips; also, a first-degree family member with the yips, and also smoking," van Wensen said. "Another interesting finding was that the golfers with the yips have better skills."

Neither alcohol consumption (P = .14) nor age (P = .6) appeared to be a risk factor, but a lower golf handicap and more years of playing were significant risk factors (both P = .002).

Table 1. Association of Risk Factors to Yips (n = 234)

Factor Yips-Positive (n = 52; 22.2%) Yips-Negative/Unsure (n = 182; 77.8%) P Value Risk Ratio (95% Confidence Interval)
Sex 45 male:7 female 105 male:77 female .00011 3.6 (1.7 – 7.6)
First-degree family member with yips 10/52 8/182 .0027 2.9 (1.7 – 4.7)
Ever smoked 15/52 24/182 .018 2.0 (1.2 – 3.3)
Alcohol (>14 IU/week) 9/52 16/182 .14 1.8 (1.0 – 3.1)

 

Poster tour leader Stanley Fahn, MD, of Columbia University, New York City, remarked that the very high prevalence of yips (22.2%) among respondents may be a result of reporting bias, owing to the fact that people with yips were probably more likely to respond to the survey. But even when applied to the entire population of golfers who were invited to respond to the survey, the prevalence was 5.7% (52/912), which was still higher than the 1% to 2% expected among a general population.

There are 400,000 golfers in the Netherlands. van Wensen calculated that as many as 23,000 could be affected by yips and that there would be more than 1 million worldwide. He recommended further studies on the epidemiology, pathophysiology, and treatment of yips and other sports-related focal dystonias.

Fahn recalled several professional athletes whose careers ended because of yips. One was New York Yankees second baseman Chuck Knoblauch. During his career, Knoblauch was Rookie of the Year, won several World Series rings, and was a player in four all-star games. He developed a problem throwing the ball to first base and racked up 26 errors in the 1999 season. He retired from baseball in 2003.

Another case that Fahn cited was that of famous professional golfer Sam Sneed. After he developed yips, "he couldn't putt any more, so he started putting croquet style...and he was winning again," he said. But the Professional Golfers' Association forbade that swing, and Sneed's professional playing career ended.

There was no funding for the study. van Wensen has disclosed no relevant financial relationships. Fahn has consulted for and has been a member of advisory boards (with honoraria) for Merz Pharma, Genervon Biotechnology, PixarBio, and Lundbeck Pharma and has received grants and research support from Genervon Biotechnology.

International Congress of Parkinson's Disease and Movement Disorders (MDS) 2019: Abstract 1351, presented September 24, 2019.

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