Although there are several epidemiological studies on the prevalence of the yips in highly skilled golfers, those studies have the limitation that the response rate was less than half of the distributed questionnaires.9,10 In contrast, our study contains a total of 1,457 completed surveys with an exceptionally high response rate of 92%. To our knowledge, this is the largest study to date to examine the yips among golfers, and the large sample size with a high response rate is one of the most vital aspects of this study.
Our findings revealed that 39% of the golfers experienced the yips, confirming the findings of previous reports with 22–48% of golfers experiencing the yips in their careers.9,10,22 As evidenced by a high percentage of respondents who were aware of the yips (98%) in our study, it is undeniably a well-known condition among golfers’ circles. This leads to the next point if golfers would self-diagnose their musculoskeletal problem to a yips-like phenomenon. In our study, golfers with an experience of the yips often had more musculoskeletal problems (56%) than those without (42%). Musculoskeletal problems were most likely to occur in the lower back, leg, or shoulder. Although it is reasonable for participants to self-diagnose their musculoskeletal symptoms as the yips, we believe that this possibility is unlikely because we conducted the questionnaire after explaining the yips to the respondents.
As reported in earlier studies, our survey also revealed that putting was the most common stroke, and jerking was the most common symptom in golfers who experienced the yips. Our study confirmed that the yips are a common problem among highly-skilled golfers, and cultural and racial backgrounds did not affect the yips phenomenon.
In our study, the golfers who experienced the yips were older and had longer golfing careers than those without the yips. Furthermore, a longer golfing career was the independent factor associated with the yips experience. Considering that increased workloads are known to be one of the risk factors for the development of task-specific focal dystonia,5,19 it is reasonable to consider that extensive repetition of fine motor control for longer durations is associated with the yips experience. In addition, the beneficial effect of changing the training method and/or hitting style suggests similar pathophysiology to the writer’s cramp in which changing the pen-grip provides an immediate beneficial effect.23 Whether the yips have neurological or psychological etiology is still debatable, our findings support the hypothesis that the yips could be a type of task-specific focal dystonia similar to the writer’s cramp4 or musician’s dystonia.1,2,5,24
In addition, it was observed in our study that the golfers with the yips experience more often had musculoskeletal problems than those without the yips experience. Ordered logistic regression analysis showed that having musculoskeletal problems was an independent factor related to the yips experience, and more severe musculoskeletal symptoms were associated with higher odds of having the yips. A previous study suggested that ulnar neuropathy can initiate specific dystonia by inducing a central disorder of motor control.25 It is supposed that musculoskeletal problems could lead to the disturbance of the afferent input to the central nervous system and cause disorganization of the motor control system.
Our study has several limitations. First, because of the cross-sectional nature of this study, our results can only suggest a relationship between the yips and various confounding factors, including musculoskeletal problems and golfing career, but cannot infer causality. To clarify the temporal relationship between musculoskeletal problems and the yips, a prospective analysis of the study is warranted. Second, our survey consisted of a self-reporting questionnaire; this might have overestimated the actual number of golfers experiencing the yips.22 Among musicians, approximately 1% of all professional practitioners are estimated to have task-specific dystonia.19 In comparison, the prevalence of golfer’s yips in this study and previous reports was substantially high, and it may be possibly contaminated with various causes of “yips-like” phenomena. To clarify the actual prevalence of the yips, further studies with neurophysiological confirmation are needed. The yips are a peculiar condition involving both neurological and psychological features, which are not only appropriate for investigation in anatomical and functional studies but also in studies involving the dynamic networks of brain connectivity.