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Updated 22 April 2016

What's eating Ernie Els?

CyberShrink discusses the golfer's yips and other performance-impairing afflictions that commonly affect sportsmen, musicians and writers.

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There’s been a flurry of news stories lately about the yips.

Futzing around

Ernie Els was the latest victim, and the web is alive with video of the great golfer futzing around,  missing the hole in a series of simple putts, carding the worst hole in the history of the Masters tournament. Ernie mumbled something about "snakes in the head" and "heebie-jeebies". Els isn’t alone, though; other yipped champions include historic greats Ben Hogan and Sam Snead, Bernhard Langer and, some suggest, even Tiger Woods.

Read: The mind - Sport's final frontier

I’ve written here before about "choking", often demonstrated by South African cricket teams when they collapse just when victory seems a certain thing. Choking is often something a team does collectively, even if the crucial errors are made by just a few players.

What are the yips ?

The word’s mainly used when a golfer suddenly misses very easy putts and, generally, when an athlete or other performer loses fine motor skills at crucial times. Notice that it’s the yips, and not a singular yip – a sort of one-man choke. It arrives suddenly, with no obvious reason, and usually in successful athletes with years of experience. It’s not properly understood and there is no recognised treatment. Some who suffer from it recover their skills, even after years, often after changing their style and technique. Some, however, don’t and are forced to abandon their career. 

We see it mostly where the athlete, at a particular stage in the game, needs to perform a very precise movement at a specific time – often seen in golf, darts, or bowling. The normally skilled movements are disrupted by unwanted jerks, usually in movements of the upper limbs. I have never seen it described in foot and leg movements, e.g. in footballers and ballet dancers but see no particular reason why it couldn’t occur there too. Maybe it just hasn’t been recognised, and may explain why some of these performers also falter and drop out.

It’s been called “dartitis” in darts, “cueitis” in snooker, “flinching” in target shooting,  and “target panic” in archery.

Why 'yips'?

The origin of the word is uncertain. Some link it to the annoying bark of a small dog, but that’s not a convincing explanation. Many people ascribe it to a former golf champion, Tommy Armour, yet it’s far older than that. He eventually had to stop playing and became a teacher.  The term has been used at least since the 1940’s. Other golfers speak of "twitches", "jitters", "waggles" and "staggers". It’s common, affecting between a third and half of all major golfers at some time, especially those who have been playing for many years.

Read: Head knocks in sport can lead to dementia

Many theories have been proposed, for instance chemical and structural brain changes that happen with ageing. It may follow some form of repetitive strain injury in the muscles involved. There are clearly problems with concentration and coordination. Another view is that it’s a type of focal dystonia (see below), but no one knows why it arises when it does.

Treatment

Many interventions have been tried. Some golfers change their grip or even switch hands; many change their putter, but relief, if it happens at all, is brief. Some resort to what are, essentially, tricks. The winner of the 1976 British Open was afraid to look at his ball or the business end of his putter, so he dabbed red nail polish on the grip and gazed at that instead. Some close their eyes before putting or ignore the ball. Langer eventually used a putter with a long shaft which he anchored against his chest.

Read: An injury-free game of golf

Focal dystonias are problematic involuntary movements affecting very specific actions in particular parts of the body. The best known example is writer’s cramp. Gowers, the great British neurologist studied this in the 1800s and related it to similar occupational problems reported by telegraph operators, knitters, seamstresses, stone masons, painters, cigarette makers, sailors, and musicians and even bagpipers. Apparently the artist who produces the Dilbert cartoons has a kind of writer’s cramp when he draws.

Yips in music

Musicians of all kinds have been afflicted. A French horn player in Frank Sinatra’s band, Glen Estrin, developed problems called embouchure dystonia, affecting how he shaped his mouth to play the instrument, becoming unable to play at all.

A great concert pianist, Leon Fleisher, found in 1964 he was losing control of the 4th and 5th fingers of his right hand. A documentary about his troubles, “Two Hands” was Oscar nominated in 2007. He changed to playing pieces written for only the left hand (there are surprisingly many of these) and became a teacher and conductor. He tried every remedy available, with no effect. In the 1990s he began a new therapy using tiny amounts of Botox to slightly weaken some of the muscles controlling the afflicted fingers, as well as intense physiotherapy (as the muscles and other tissue had been damaged by the years of cramping). He was able to resume playing normally, with both hands. 

 Read: Dealing with muscle cramps

Botox also probably wouldn't be useful in a golfer, as interfering with muscle balance might help with putting, but may cause problems with the other shots.

Yips are complex and puzzling.  A yipped player may make the stroke perfectly when there’s no ball involved. Some may be fine in reverse – a right-handed golfer putting like a left-hander, and vice versa. It hasn’t been seen in blind golfers. It may run in families. The twitch comes either precisely when the ball is hit or very shortly before.

Though yips are seen mostly in older and highly experienced golfers, someone even tested people who had never played golf and had never before used a putter; some 20 % of them showed severe yips when trying to putt for the very first time.  

Psychology clearly plays a part

Yips usually affect only the dominant hand, and focal dystonias in musicians also tend to be one-sided, though this varies according to instrument. With keyboards it’s mostly the right-hand and with string players it’s mainly the left, but guitar players are mainly afflicted in the right hand. This may be less odd than it looks, if the hand needing to perform the most complex tasks is affected. 

Though there’s been a focus on neurological aspects, psychology clearly plays a part. The trouble arises when there is a pause before the intricate movement, which means that there's time to think about the action before it is carried out. In tennis, for instance, yips are seen with the serve, and with returning a high lob – when there has been time to think about the action.

A pianist usually has no problem when “playing” on a table top rather than the keys, or when wearing gloves. A violinist or guitarist can be fine on an instrument with no strings. In an orchestra, some musicians “double”, i.e. play more than one instrument, perhaps clarinet and flute, and may experience mouth problems with one and not the other. Some pianists with dystonia are fine playing the organ.

Read: Secrets of writer's cramp revealed

In an example more familiar to most of us, people with writer’s cramp may only be troubled by some letters and not others. Similarly, a stutterer may be fine when singing,  or whispering,  when speaking in a phony accent,  or speaking wearing headphones so they can’t hear their own voice ; someone with writer’s cramp can usually type, draw, or knit.

As always when trying to puzzle out why a condition arises, we should be cautious in our thinking. Don’t assume there must be only one cause, and just because problems look similar doesn’t necessarily mean they have exactly the same cause. And of course we need to distinguish between yips and simply making a mistake or having a bad day and looking for an excuse.

High-stakes moment

I wonder about the major tennis players who demonstrate “superstitions” before their serve: tapping the racquet, plucking the strings or bouncing the ball a specific number of times. Is this an isolated superstition or perhaps a way of warding off a variant of the yips.

Read: Feeling powerless leads to paranoia

They’re usually seen at a high-stakes moment, or when the person is specially anxious, but some experience the yips while calmly playing alone. The key issue seems to be whether the person can stay focused on the task and avoid distractions.

It reminds me in some ways of a condition called "intention tremor", seen in many neurological disorders where a person may have a slight degree of hand trembling which gets increasingly severe when they try to do something particular, even when thinking about what they’re about to do. You may intend to pick up a pen, but undershoot or overshoot the target. We see it in Parkinson’s disease, multiple sclerosis and many other similar disorders. Here there is definitely brain pathology at work, though in ordinary yips no such problems have been discovered to be involved.

Thinking of other people whose work involved highly skilled and critically important movements, I have not noticed any reports of the yips or anything like it in artists who paint, or in surgeons. I've known surgeons with shaky hands or clumsiness who have stopped operating, but have found no studies of the phenomenon and no nickname for it.

Incidentally the legendary Indie rock band “Half Man Half Biscuit” (one of my favourite band titles) recorded a song “My Baby Got the Yipps”, apparently about a troubled golfer: "She goes out in 32 but comes home in 54." 

Read more:

Rugby World Cup: are our players 'choking' themselves to death?

Meditation can improve sports performance  

What are sports injuries?

Professor MA Simpson is Health24's CyberShrink. A South African psychiatrist, he qualified in medicine and in psychiatry in Britain. He has been a senior academic, researcher, and Professor in several countries. Read more of his columns.

 

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