We’re all N = 1
November 1, 2007
January 1, 2008
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Golfer’s yips

The case of the curious golf affliction – the “yips”

A lot of my patients come to me because of chronic pain. So it’s no surprise that I see a lot of athletes – bikers, runners, tennis players –seeking help in restoring their performance levels. However, nobody has come to me, yet, with the specific request that I help their golf game. I’ve helped some here and there, but it’s always been a secondary consequence of treatment (a couple examples: |1|2|).

Well, thanks to an article in the journal of the British Medical Acupuncture Society (BMAS), I’m now ready to be of more direct help. Seems there is a condition that uniquely attacks golfers – the oddly named “yips.” It’s not really painful. Unless you’re a golfer. Adding about five strokes per round can hurt a lot.

Little did I know that this condition has been the subject of intense research (cf. A Multidisciplinary Study of the ‘Yips’ Phenomenon in Golf, Sports Medicine, 2000, 30(6) 423-437, and The ‘Yips’ in Golf, Sports Medicine, 2003, 33(1) 13-31). And now, thanks to BMAS (and their generous presentation of many articles through their web site), a role for acupuncture is revealed: Acupuncture for Treatment of the Yips, a Case Report, by Palle Rosted (Acupuncture in Medicine, 2005, 23(4): 188-189).

What are the “yips”?

Many amateur golfers, and more than a small number of professional ones, lose control of the muscles in their arms in such a way that they can’t smoothly move a putter to and fro. Their arms can cramp or sometimes make involuntary movements. Aggravating if you’re an amateur, a catastrophe if you’re a professional.

A continuum of causes

The subtitle of the 2003 article in Sports Medicine is “A Continuum Between a Focal Dystonia and Choking.” It turns out that the yips are a psychoneuromuscular impediment. Yikes. Multiple causes here. From a localized neuromuscular problem to a psychosocial one – choking in common parlance.

The article on treating with acupuncture

Why do I like this article so much? First, it’s based on a sample size of one. That’s right, one golfer. One 65 year old Brit with a handicap of 14. Who would ever take seriously a study of sample size one? Well, me. If you read my blog on sample sizes in research and practice you’ll know why. Suffice it to say here that in an encounter between caregiver and patient, the sample size is always one. What I learn about one golfer today can help one golfer tomorrow.

Second, because it encompasses what acupuncture and Chinese medicine in general are so good at. The yips are a symptom. And we don’t attack symptoms willy-nilly. What is the cause of this symptom? Discovering this will take both rational evaluation and intuitive diagnosing. It takes listening. Same for the treatment. Rationality and intuition. Science and art. From sample sizes of N=1031 and N=72 describing the phenomenon in the two Sports Medicine articles, one golfer (N=1) gets treated in such a manner that he overcomes an impediment. I love it.

The cure for the N=1 golfer

Whatever physical muscular problems are involved with the yips, they are exacerbated by performance anxiety. The patient of this study did not clearly present physical or anxiety-related symptoms, so Rosted chose a combination of points to address the condition. (The details: GV20, EX-HN-1 [Si Shen Cong: four points one cun from GV20], and TE5.) The symptoms were gone after one treatment (a total of five were given), and there were no relapses by the 24-month follow-up.

Final thoughts

Performance anxiety and repetitive motor skills are important in lots of people’s lives. Maybe this isn’t so unique to golfers, after all. So, OK, I’m ready. Bring on the golfers, musicians, and poker players and let’s see what kinds of psychoneuromuscular impediments we can resolve. One at a time.