Dear Doctor: I had scoliosis as a child, and now, at age 72, I’m living with kyphosis in my middle and upper back. It’s very painful, and I would like to know more about it.

Dear Reader: You’re referring to hyperkyphosis, also often referred to simply as kyphosis, a technical term for the natural and normal curvature of the upper back. Hyperkyphosis means that the curve has become abnormally amplified. It’s a condition in which the middle and upper portions of the spine develop an exaggerated forward curvature, which can cause the appearance of a rounded back. In more severe cases, hyperkyphosis results in visibly hunched posture, or what looks like a hump on the back.

The condition occurs because the thoracic vertebrae -- or the middle portion of the back -- have lost the rectangular shape that keeps the spine upright. Instead, they have become wedge-shaped, which causes the spine to have a forward arch. Kyphosis can be congenital, or present at birth. It may result from Scheuermann’s disease, a condition that can arise during the growth spurt of adolescence. It sometimes develops over time as the result of chronically poor posture. And it can be age-related, the result of osteoporosis or muscle weakness, or a combination of the two.

Due to the hormonal changes of menopause, which result in a decrease in bone density, age-related kyphosis is more common in menopausal and postmenopausal women than it is in older men. It happens because the specialized bone cells that form the hard, external surface of each vertebra can no longer renew at an optimal rate. This weakens the outside of the vertebra, and leaves the inner part, a more fragile structure that resembles a honeycomb, vulnerable to becoming “squeezed” or compressed.

Kyphosis can range from mild to severe. In less-serious cases, an individual may experience stiffness, pain and fatigue, but won’t necessarily have a visibly exaggerated spinal curve. Moderate cases of the condition may result in muscle weakness and decreased mobility. In more severe kyphosis, patients may suffer compression fractures in their vertebrae, which can cause the spine to collapse forward. Compression fractures can be caused by everyday activities such as lifting a bag of groceries, or even just twisting or coughing.

The condition is diagnosed with a physical exam and imaging tests. The spine’s natural curve ranges from 20 to 45 degrees. A curvature of more than 50 degrees results in a diagnosis of kyphosis. Treatment depends on the severity of the condition. Milder cases respond to the use of anti-inflammatories for pain and targeted exercise to improve posture and increase muscle strength. There is some evidence that exercises using a weighted backpack can be helpful. Although back braces may be used to relieve pain, they will not cause the adult spine to straighten.

Surgery for kyphosis is considered in severe cases only, such as when breathing is compromised, or when neurological symptoms, such as limb paralysis or weakness, develop. In those cases, spinal fusion may be recommended.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: A few months ago, my husband and I helped our oldest son move into his first apartment. I don’t know what happened exactly, but my lower back has been hurting ever since. I would rather not use any medications and have heard that yoga can be good for back pain. Is this true?

Dear Reader: First, as fellow parents, we want to congratulate you on the milestone of your son’s first apartment. It’s not surprising that you may have accidentally overdone it with the heavy lifting.

The localized pain you describe sounds like muscle strain, which can result from overuse. Other causes could be poor posture or body mechanics during tasks that involve lifting, pulling or twisting. Another common type of back pain, which originates in the lower back or buttocks region and radiates down one leg, is associated with bulging or ruptured discs. These can press on the sciatic nerve, which will cause sharp, stabbing pain.

The good news is that yoga can help you manage and ease the type of lower back pain you have described. The gentle and deliberate movements associated with the practice of hatha yoga make it possible to isolate specific muscle groups. The poses are designed to alternately strengthen muscle groups and then gently stretch them. The movements are also slow enough that you can stop the instant you feel discomfort or pain. Yoga is also effective at developing “core strength,” or the abdominal muscles that support an upright spine and proper alignment.

Hatha yoga involves certain “poses” that can be helpful for lower back pain. This portion of an asana, or yoga pose, is typically accompanied by slow, deep breathing, which results in additional relaxation. People with lower back pain who seek relief through hatha yoga report that the practice gives them enhanced awareness of proper spinal alignment, which promotes good posture.

Check with your doctor or physical therapist before starting a yoga program for lower back pain. When done improperly, any type of exercise, even yoga, can aggravate the injury and make matters worse. (And please note that yoga is not recommended for anyone with a slipped disc or a spinal fracture.)

If your health care provider agrees that yoga is a good fit for your situation, you can take some easy steps to make sure you stay safe. Consider classes that are designed specifically to address lower back pain. Special yoga classes often are available at senior centers or community centers. If a general yoga class is the only option in your area, tell the instructor that you have a back injury. He or she may be able to tailor the poses to your specific needs and reduce the risk of further harm to your back as you perform the poses.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: I am a 77-year-old man who used to exercise regularly. I was diagnosed with polymyalgia rheumatica a couple of years ago. Sometimes I feel like it is going to disappear, and other times it seems to worsen. Are there any new remedies?

Dear Reader: Polymyalgia rheumatica, also known as PMR, is an inflammatory condition that affects joints and muscles, most often in the neck, shoulders, hips, thighs and lower back. Some patients report a gradual onset of the condition. For others, it appears quickly, seemingly overnight.

Symptoms of PMR include significant muscle pain, accompanied by ongoing stiffness. These both tend to increase after periods of rest or inactivity, and can be severe enough to interrupt sleep. Pain and stiffness are most pronounced in the morning. The stiffness caused by PMR often improves within a few hours after waking -- being active helps, too -- but the pain remains. Additional effects may include flulike symptoms such as fever, malaise and exhaustion. PMR is rarely seen in anyone younger than 50, and is most often diagnosed at age 60 and older. It’s also more common in women than in men.

Although the cause of PMR isn’t known, it is strongly suspected to be an autoimmune disease. That means the body's immune system is attacking its own tissues, giving rise to the systemic inflammation that’s causing the pain and stiffness. Research into PMR has also suggested a genetic component. The condition appears to be more common among people of North European descent than it is among those from the Mediterranean.

As you probably know, having lived with the condition for a few years, the primary treatment for PMR is corticosteroids, such as prednisone. Patients report a swift reduction in pain and stiffness often two or three days after starting steroid therapy. Due to potential complications associated with steroids, including an increased risk of infection, diabetes, high blood pressure and osteoporosis, the goal is to find the lowest dose possible to manage pain. Once symptoms are under control and the results of certain blood tests show improvement, steroid therapy is gradually tapered to the lowest effective dose.

There are currently no new treatments for the condition. A class of medications known as disease-modifying antirheumatic drugs, or DMARDs, are sometimes used to reduce reliance on steroids. And there is increasing interest in the use of monoclonal antibodies, which are lab-created molecules that act on, or with, the immune system.

Some people living with PMR report improvement when they switch to a low-inflammation diet, such as the Mediterranean or DASH diets. Foods that are associated with anti-inflammatory properties include leafy greens, fruit, nuts, whole grains, fatty fish and green tea.

If you haven’t already done so, we urge you to let your doctor know whenever your symptoms get worse. A challenge of aiming for a minimal dose of any medication is that the dosage might drop below what is necessary. Ask your doctor if a slight adjustment in your medication is needed.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)