Most of you are familiar with that ad on TV in which a Bob Vila type tells the young couple that the dream house they bought "will take six months and $10,000 to fix up, but the good news is that I saved a ton of money on my car insurance!" Well, that's sort of what I have to report about flinching.
As most of you know I have an interest in flinching that dates back a number of years when Shotgun Sports and I did a survey on flinching that appeared to be the first of its kind when published (the article is in my book, Mental Training for the Shotgun Sports.) In that survey we found that the average flincher was older and more experienced and that flinches manifested themselves in a variety of ways. I suggested a number of solutions to deal with flinching and offered a schema of rehabilitation and prevention based on the knowledge that we had at the time. I was not able to characterize the problem in physiological terms nor was I able to determine a base cause for flinching.
The good news is that the science on flinching has been done.
Actually the scientific research, done by the Mayo Clinic, was done on golfers. The "Yips" (named after a group of people in the 1939 movie Wizard of Oz) is similar to a flinch (I think it is the same thing) in that it only occurs in special circumstances (usually putting but sometimes during another type of stroke), it is very brief, and it occurs in older more experienced golfers who often had a better handicap than the not-yips group. In addition the usual treatment for the yips consists of learning to putt in a totally different way from the standard. All of this is identical to flinching.
But the study also found that there was a "co-contraction" of flexor and extensor muscles in one subgroup of golfers with the yips. In other words there was competition between the two sets of muscles that drive the forearm (and hence the grip) that occurred just as the golfer was putting. If this happened to a shooter, he or she would not be able to pull the trigger.
The Mayo Clinic has remote offices in Florida and Arizona in areas noted for their superb golf courses (Scottsdale and Jacksonville Beach) so it is not unusual that a lot of golfers go to these branches of what may be the best medical system in the world. In addition, the Scottsdale branch is practically next door to Arizona State University whose Exercise Science department lead all the research into shooting under the auspices of Dan Landers, Ph.D. In the mid 1980s. The latter is important because one of Dr. Landers students, Debbie Crews, Ph.D. wrote several papers on choking and attentional patterns in golfing in the late 1990s. This was not lost on the Mayo Clinic researchers who were being asked by several sources (read gave money) to look into the subject of the yips.
The result was a series of studies, outside criticisms, and clarifications (all typical of clinical research) that resulted in the last paper presented by Dr. Charles H. Adler, MD, Ph.D. at the American Academy of Neurology in April of 2005. In this study the team looked at 20 golfers, half of whom had the yips, using electroencephalograms (EEG) and electromyography (EMG) to observe what happened during the yips and to contrast similar errors in non-yip golfers. The EMGs of those golfers with the yips were perfectly normal until 200 milliseconds before they hit the ball at which time a jerk of forearm muscles occurred. Half of the golfers with the yips had the co-contractions mentioned above while the others had only extensors or flexors move involuntarily. The results of this small study is the notion that the yips is not psychogenic but physiological.
Those with yips averaged 58 years of age (our flinchers were 55 years old) and the yip free group was 43 years old (44 years old for our study.) The EEG study also showed changes in several of the leads in the subjects who had the yips. Dr. Adler's conclusion is that they yips is a "focal dystonia" which means that it is limited to a specific area of the body.
Prior to this study most of the attention to the yips (and flinching and other similar problems) focused on the psychological aspects. Dr. Crews has done extensive research on EEG differences between successful and unsuccessful golfers and has shown that the latter don't use the right brain when they play. These and other studies give scientific validation to many of the mental training methods taught here and other places such as relaxation and visualization to promote right brain involvement in shooting and other sports actions. As the studies progressed it became obvious that there was a difference between "choking" (a failure or disintegration of the sports action) and the yips (defined as a sudden involuntary contraction of the muscles involved in the sports action) and that most likely there was a relationship but not a direct one to one cause and effect.
Looked at scientifically, this only made sense. The part of the brain that mediates anxiety and the part that is involved with dystonia are separate from one another. Yips, flinching, writers cramps and other similar dystonias all have similarities that are not explainable by anxiety. The conditions are acquired by previously adept persons, they are episodic, a change in technique often resolves the issue, at least temporarily, and the person affected has been performing the action for a considerable period of time.
In contrast, anxiety can strike at any time but usually only at the beginning of a career is it significant unless there are changes in the environment. A change in technique can on occasion clear the anxiety, but most of the time the learning curve of a new technique makes the person more anxious unless he or she knows that the learning curve always has a downward path before it improves. Anxiety can affect the muscles but almost always in the fight or flight total body sense, not one isolated muscle or muscle group.
Those researchers who focused on the mental aspects did so for the obvious reason, they were interested in the mental side of the issue. Mayo clinic did the same thing with their admirable research until Dr. Adler, who is a movement disorders expert, came on the scene. He applied research tools that brought the dystonia issue to the forefront.
So what does this mean if you have a flinch?
The good news is that we know a lot more about the condition. We know that flinching is not always due to anxiety, we know that the longer you shoot , the more likely you will develop a flinch, we know that flinching is a condition that is not directly related to anxiety or match stress. Of course we already knew that anyway but what we did not know was the specific mechanism.
In fact we still may not know the exact mechanism, but we have a better idea. It is very common in medical research to have a general idea of what causes something and not have a specific cure or treatment because we have not done the difficult work of finding and proving a treatment. This is the bad news part. We don't have a treatment, at least we don't have a new innovative and successful treatment. We do have the old fashioned methods of dealing with the problem including the release trigger, but the release trigger is not all that successful.
Dr. Adler has suggested that a variety of medications (use of which is illegal in the Olympics, by the way, but are common medications used to treat a variety of illnesses) might be helpful, but the usual method of treating the serious focal dystonias (such as torticollus, a painful spasm of the neck) is Botox which is not appropriate for a sports specific short term problem.
Other methods such as reducing anxiety are helpful but not specific. So the search goes on.
So what does this mean if you have a flinch? Are you going to develop some horrible neurological disease and end up in a wheelchair? Of course not!! The yips, flinching, writers cramp, etc. don't belong in the same class as the medically serious illnesses known as focal dystonias. Instead, they are an overuse syndrome at worst and an annoyance because they interfere with achieving your goals in shooting or golf, or whatever pursuit that they occur in. It is a sign of age, like vision problems, and there will be a good treatment eventually. In fact, because there are more golfers with money to spend than there are persons with torticollus, I will venture to say that the yips will continue to draw interest and the problem solved well before the classical and more serious movement disorders see a similar cure. If you don't shoot, you will not have a flinch, it is as simple as that.
I will try to keep you abreast on the research on flinching/yips. There is plenty more to come.
MJ Keyes, MD
29 May 2005