What is the most feared injury for a baseball player? Is it a torn ulnar collateral ligament, often requiring Tommy John surgery? Or perhaps a torn rotator cuff? A broken hamate bone? Surprisingly, it’s none of these. The most dreaded condition is a hidden one, with no standard treatment and an unpredictable prognosis. Its severity and impact on a player are unknown. This condition is called “The Yips,” and it can quickly derail the career of any ballplayer if they are unlucky enough to be afflicted. To better understand it, let’s look at one of the most famous examples in baseball history.
In the year 2000, Rick Ankiel was one of the top pitching prospects in all of baseball. The St. Louis Cardinals drafted him in the second round of the 1997 draft, where he received a $2.5 million signing bonus.1 At the age of 20, he was starting to come into his own as a baseball star. That is, until his career took a turn for the worse.
At the onset of the 2000 postseason, Ankiel was set to start the first game of the National League Division Series against the Atlanta Braves. The game was off to a good start until he reached the third inning. Suddenly, Ankiel lost control of his fastball. He uncharacteristically walked four batters and threw five wild pitches before being pulled from the game. Ankiel had never had problems with controlling his pitches. Throwing a ball in the strike zone is something that a ballplayer learns in little league. Nevertheless, fans and analysts chalked it up as a bad day.
The following week, Ankiel was scheduled to start against the Mets in the National League Championship Series. Unfortunately, the game picked up where the last one left off. Ankiel walked five of the ten batters he faced and was pulled from the game in the first inning. Eventually, Ankiel would be sent down to the minor leagues; he never truly recovered, and his pitching career was effectively over.2
To put it simply, the Yips occurs when an athlete suddenly loses the ability to perform a task they once did with ease. But what exactly happens at the physical level when a player gets the Yips? Is there a physiological basis for the tragedy that Ankiel endured?
A systematic literature search was conducted to better understand the current scientific perspective on the Yips in baseball. The results included review articles, cross-sectional studies, and case reports.
According to the literature, the Yips is a psychoneurobiological disorder with two suspected mechanisms. The first is a psychogenic impairment in coordination, classically associated with performance anxiety. The second is focal task-related dystonia, where involuntary muscle contractions in a specific area of the body impair coordination.3 This binary classification system is based on a 2006 study by Stinear and colleagues analyzing muscle activity in golfers that categorized the Yips into two subtypes: focal dystonia (Type I) and choking (Type II), which involves anxiety-related symptoms.4 More recently, however, scientists are starting to look at the Yips more holistically, placing dystonia and anxiety on a continuum where each case has a combination of both factors.5,6
So, according to the literature, which type of the Yips did Ankiel experience in the early 2000s? While it is impossible to know with certainty, one can better characterize the Yips by understanding the circumstances in which they occur, as well as the athlete’s “recovery.” Rick Ankiel did not pitch effectively again after the 2000 postseason. Even in low-pressure settings in the minor leagues, he struggled to control his pitches. One could use this information to suggest that Ankiel was likely suffering from a focal task-related dystonia.
To contrast this, an example of a purely psychogenic manifestation of the Yips was seen in 2015, when Elvis Andrus made three consecutive errors in the high-pressure game five of the American League Division Series. Andrus is a two-time all-star, and a solid defender statistically.7 Each error also involved a different set of circumstances, while Ankiel’s issue only involved commanding his pitches. Many believe that this episode was due to the extreme stress of a close game with a lot on the line; Andrus would ultimately recover quickly from this event and remain a solid defender for the rest of his career.
Given the suspected psychological and neurological basis for the Yips, what treatment modalities are most effective? While case studies have seen positive effects with invasive treatments like intramuscular injections and even brain surgery,8,9 the data does not suggest that any of these are effective on a large scale. Most of the classical advice regarding the Yips involves counseling, stress management, and physical rehabilitation with success for most athletes.
While there are a few athletes who never conquer the Yips, the vast majority eventually overcome it. As for Rick Ankiel, though his pitching career came to an end, he found new life when he was demoted all the way to the rookie leagues. Ankiel crawled his way back to the major leagues as an outfielder,1 where he had ample success over a seven-year period. Oh, and his arm was quite accurate from the outfield.
Works Cited
1. Rick Ankiel Stats, Height, Weight, Position, Rookie Status & More. Baseball-Reference.com. Accessed August 24, 2024. https://www.baseball-reference.com/players/a/ankieri01.shtml
2. Rick Ankiel. In: Wikipedia. ; 2024. Accessed August 24, 2024. https://en.wikipedia.org/w/index.php?title=Rick_Ankiel&oldid=1238286527
3. Lenka A, Jankovic J. Sports-Related Dystonia. Tremor Other Hyperkinet Mov (N Y). 11:54. doi:10.5334/tohm.670
4. Stinear CM, Coxon JP, Fleming MK, Lim VK, Prapavessis H, Byblow WD. The yips in golf: multimodal evidence for two subtypes. Med Sci Sports Exerc. 2006;38(11):1980-1989. doi:10.1249/01.mss.0000233792.93540.10
5. Aoyama T, Ae K, Soma H, Miyata K, Kajita K, Kawamura T. Motor imagery ability in baseball players with throwing yips. PLoS One. 2023;18(11):e0292632. doi:10.1371/journal.pone.0292632
6. Aoyama T, Ae K, Taguchi T, et al. Spatiotemporal patterns of throwing muscle synergies in yips-affected baseball players. Sci Rep. 2024;14:2649. doi:10.1038/s41598-024-52332-9
7. Elvis Andrus Stats, Height, Weight, Position, Rookie Status & More. Baseball-Reference.com. Accessed August 25, 2024. https://www.baseball-reference.com/players/a/andruel01.shtml
8. Horisawa S, Kushi K, Kawamata T, Taira T. Successful Treatment of Baseball-Related Dystonia (Yips) with Ventro-Oral Thalamotomy. Movement Disorders Clinical Practice. 2023;10(3):507-509. doi:10.1002/mdc3.13637
9. Nakane S, Ando Y, Matsuo H. Yips preceding baseball-related dystonia. Parkinsonism & Related Disorders. 2018;50:128-129. doi:10.1016/j.parkreldis.2018.02.018
Benson Lagusis is a member of the University of Arizona College of Medicine - Phoenix Class of 2026. He graduated with a B.S. in Exercise Science from Northern Arizona University before earning a Master's degree in Biomedical Sciences from Midwestern University. Benson played baseball in college, and is interested in sports medicine and health promotion/education. During his free time, Benson is an avid hiker, reader, and Netflix binge-watcher.