Yips (Focal Dystonia)

What Is Yips (Focal Dystonia)? What Are The Causes Of Yips?

The yips refer to a very real physical condition called focal dystonia. Dystonia is a neurologic disorder characterized by involuntary movements or spasms of small muscles. In focal hand dystonia, the fingers either curl into the palm or extend outward without control.
According to Medilexicon's medical dictionary:

Dystonia is a general term describing a variety of musculoskeletal problems resulting from overuse or repetitive stress, particularly applied to the fine muscle problems encountered by professional musicians.

In golf, putting requires precision and fine motor control of the small muscles that control these movements. In this case the yips may be related to overuse and fatigue of these small muscles.

Generally, dystonia is an uncommon condition. However, it is one of the most common neurological conditions. Dystonia can affect people of all ages, including children. However, symptoms most commonly begin when a person is between 40 and 60 years old.

What are the symptoms of Focal Dystonia?

A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, drowsiness may be a symptom while dilated pupils may be a sign.

Symptoms vary according to the kind of dystonia involved. Focal dystonia early symptoms may include loss of precision muscle coordination (sometimes first manifested in declining penmanship, frequent small injuries to the hands, and dropped items), cramping pain with sustained use and trembling. Significant muscle pain and cramping may result from very minor exertions like holding a book and turning pages.

Direct symptoms may be accompanied by secondary effects of the continuous muscle and brain activity, including disturbed sleep patterns, exhaustion, mood swings, mental stress, difficulty concentrating, blurred vision, digestive problems and short temper. People with dystonia may also become depressed and find great difficulty adapting their activities and livelihood to a progressing disability.

In some cases, symptoms may progress and then plateau for years, or stop progressing entirely. The progression may be delayed by treatment or adaptive lifestyle changes, while forced continued use may make symptoms progress more rapidly.

What are the causes of Focal Dystonia?

Environmental and task-related factors are suspected to trigger the development of focal dystonia because it appears disproportionately in individuals who perform high precision hand movements such as musicians, engineers, architects and artists. It is generally "task specific," meaning that it is only problematic during certain activities.
Other key causes include nerves, anxiety or "choking" that many athletes experience during high-stress competition and overuse of the muscles involved in fine-motor control and precise movements.

In cases of primary dystonia, it is thought that the basal ganglia does not produce enough neurotransmitters, or it produces the wrong type of neurotransmitters, resulting in problems with muscle function. The basal ganglia is a collection of brain cells at the front of the brain. They are responsible for sending messages from the brain to various muscles in order to move them.

Secondary focal dystonia can have causes stemming from more serious conditions such as Parkinson's disease (a neurological (brain-related) condition that is caused by a lack of a neurotransmitter called dopamine), Huntington's disease (an inherited condition that is caused by a lack of cholesterol in the brain) and Wilson's disease which is a genetic condition that leads to a build-up of copper in the tissues of the body. Multiple sclerosis, and cerebral palsy also may cause levels of the yips as they are nervous system function related.

Diagnosing Focal Dystonia

It is important to confirm whether your dystonia is primary or secondary. Confirming the type of dystonia is important because the treatment of secondary dystonia can vary from that of primary dystonia, depending on the underlying cause. Treating the underlying cause can in turn help to control symptoms of secondary dystonia.

Electrical sensors (EMG) inserted into affected muscle groups, while painful, can provide a definitive diagnosis by showing pulsating nerve signals being transmitted to the muscles even when they are at rest. When called upon to perform an intentional activity, the muscles fatigue very quickly and some portions of the muscle groups do not respond (causing weakness) while other portions over-respond or become rigid. This can be an effective diagnosis technique of more severe focal dystonia.

What are the treatment options for Focal Dystonia?

Reducing the types of movements that trigger or worsen dystonic symptoms provides some relief, as does reducing stress, getting plenty of rest, moderate exercise, and relaxation techniques.

This condition is also often treated with injections of botox, a commercially prepared form of botulinum toxin. Botox, however, merely targets the symptoms of the disorder and is not a cure for dystonia. Botulinum toxin stops the neurotransmitters that are responsible for muscle spasms from reaching the affected muscles. It is given by injection directly into the affected muscles.

Botox treatments are a temporary fix as the effects of the injection usually last for three months after which time one will need a further injection.

Clonazepam, an anti-seizure medicine, is also sometimes prescribed. However, for most their effects are limited and side effects like mental confusion, sedation, mood swings and short-term memory loss occur.

Anticholinergics are a type of medication that treat some types of focal dystonia. However, they are not effective for everyone. Anticholinergics work by blocking the release of a neurotransmitter called acetylcholine, which is known to cause muscle spasms in some cases of dystonia.

Finally, cannabidiol, one of the non-psychoactive cannabinoids found in cannabis sativa, was shown in independent studies to have reduced dystonic symptoms in all participants by up to 20-50%.

Preventing Focal Dystonia

There is no known way of preventing focal dystonia. To help reduce chances of getting this condition, it is important to take steps to reduce your risk of infection, stroke, trauma, and carbon monoxide poisoning or heavy metal poisoning.