title: A multidisciplinary study of the 'yips' phenomenon in golf: An exploratory analysis.
abstract: BACKGROUND
  The 'yips' is a psychoneuromuscular impediment affecting execution of the putting stroke in golf. Yips symptoms of jerks, tremors and freezing often occur during tournament golf and may cause performance problems. Yips-affected golfers add approximately 4.7 strokes to their scores for 18 holes of golf, and have more forearm electromyogram activity and higher competitive anxiety than nonaffected golfers in both high and low anxiety putting conditions. The aetiology of the yips is not clear.
  
  
  OBJECTIVE
  To determine whether the yips is a neurological problem exacerbated by anxiety, or whether the behaviour is initiated by anxiety and results in a permanent neuromuscular impediment.
  
  
  METHODS
  In phase I, golf professionals assisted investigators in developing a yips questionnaire that was sent to tournament players (<12 handicap) to establish the prevalence and characteristics of the yips. Phase II measured putting behaviour in scenarios that contribute to the yips response. Four self-reported yips and 3 nonaffected golfers putted 3 scenarios using an uncorrected grip and a standard length putter. Heart rate was superimposed on the videotape and the putter grip was instrumented with strain gauges to measure grip force. Electromyograms and relative putting performance were also measured.
  
  
  RESULTS
  The questionnaire was sent to 2,630 tournament players, of whom 1,031 (39%) responded (986 men and 45 women). Of these, 541 (52%) perceived they experienced the yips compared with 490 (48%) who did not. Yips-affected golfers reported that the most troublesome putts were 3, 4 and 2 feet (0.9, 1.2 and 0.6 metres) from the hole. Fast, downhill, left-to-right breaking putts and tournament play also elicited the yips response. Golfers affected by the yips had a faster mean heart rate, increased electromyogram activity patterns and exerted more grip force than nonrffected golfers and had a poorer putting performance.
  
  
  CONCLUSIONS
  For <10 handicap male golfers and <12 handicap female golfers, the prevalence of the yips is between 32.5% and 47.7%, a high proportion of serious golfers. This high prevalence suggests that medical practitioners need to understand the aetiology of the yips phenomenon so that interventions can be identified and tested for effectiveness in alleviating symptoms. Although previous investigators concluded that the yips is a neuromuscular impediment aggravated but not caused by anxiety, we believe the yips represents a continuum on which 'choking' (anxiety-related) and dystonia symptoms anchor the extremes. The aetiology may well be an interaction of psychoneuromuscular influences. Future research to test the effect of medications such as beta-blockers should assist in better identifying the contributions these factors make to the yips phenomenon.
authors.affiliation: Department of Laboratory Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA. smith.aynsley@mayo.edu
authors.forename: A M
authors.initials: AM
authors.lastname: Smith
authors.forename: S A
authors.initials: SA
authors.lastname: Malo
authors.forename: E R
authors.initials: ER
authors.lastname: Laskowski
authors.forename: M
authors.initials: M
authors.lastname: Sabick
authors.forename: W P
authors.initials: WP
authors.lastname: Cooney
authors.forename: S B
authors.initials: SB
authors.lastname: Finnie
authors.forename: D J
authors.initials: DJ
authors.lastname: Crews
authors.forename: J J
authors.initials: JJ
authors.lastname: Eischen
authors.forename: I D
authors.initials: ID
authors.lastname: Hay
authors.forename: N J
authors.initials: NJ
authors.lastname: Detling
authors.forename: K
authors.initials: K
authors.lastname: Kaufman
mesh_terms: D000222:Adaptation, Physiological; D000223:Adaptation, Psychological; D001007:Anxiety / Q000150:complications*; D004576:Electromyography; D005260:Female; D006055:Golf / Q000502:physiology* / Q000523:psychology*; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000294:innervation*; D011379:Prognosis; D018570:Risk Assessment; D011795:Surveys and Questionnaires