Yips

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.

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 provider, they may refer you to a health care provider 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 health care team.

For yips, some questions to ask your provider 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 health care provider may ask detailed questions about how and when your symptoms occur. Your provider 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 health care provider 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?