DEAR DR. DONOHUE: My son plays hockey. In one of the last games of the season, he tripped and hit his head on the ice. The team doctor said he had a concussion and wouldn’t let him play the rest of that game or the final game of the season. He says he might not let him play next year.

At no time was the boy unconscious. Can you have a concussion without losing consciousness? My husband said all he had was a ding and the doctor is making far too much of this.

Will you define concussion for us? Do you think it’s dangerous for the boy to resume playing next season? My son is quite upset by this. – W.C.

ANSWER: More than 300,000 sports-related concussions occur every year in the United States and Canada. Experts argue over the definition of a concussion, but most do not require a loss of consciousness to label a head injury a concussion. The prime criterion is a change in mental state. That means the injury has caused a person to be confused, to have lost memory for what happened before the accident or to be unable to remember things after the accident, to be dizzy or to have a headache.

If an athlete suffers a concussion and returns to play too soon, a second head injury can cause permanent brain damage. Furthermore, having had one concussion makes a person more susceptible to having another.

When all concussion symptoms and signs are gone, an athlete can return to play. If there were good tests to determine the extent of brain injury, everyone could breathe more easily when it comes to deciding when it is safe to resume the sport. There aren’t any such tests. A special brain scan called diffusion tensor imaging might be able to resolve problem cases, but it’s only in the development stages.

I suggest you take the boy to a neurologist for an expert opinion. It sounds like the team doctor is conservative, but that’s not such a bad position when it comes to protecting the brain. If a neurologist clears the boy, the team physician should do the same.

DEAR DR. DONOHUE: I am 79 and my balance has gone south. What kind of exercises would help me? – R.D.

ANSWER: Balance depends on good vision, proper functioning of the balance organ in the inner ear and intact proprioception. Proprioception is a complicated, innate ability to judge where the body is at any given moment. It’s an ability that diminishes with age. I say all this so that you’ll have the family physician go over you to see if your balance loss comes from a treatable physical condition.

Exercises can restore stability. Don’t attempt them when you are alone. You need a person there to grab you if you begin to wobble and are on the verge of falling.

One simple exercise is standing on one leg and having the other leg swing back and forth in front of you like a pendulum. Switch legs and repeat the pendulum swing. Repeat the exercise as many times as is comfortable.

Another exercise is simply to stand on one leg with the other leg bent 45 degrees at the knee. Try standing on one leg for five seconds. Then switch legs. Repeat this exercise as many times as you can, and gradually lengthen the time spent on one leg.

DEAR DR. DONOHUE: My grandson is 16 years old. He lifts weights and is very healthy. He recently has been diagnosed with scoliosis.

At times he suffers from lower-back pain. He sleeps on his stomach. Could his sleeping position or his scoliosis be the source of his pain? – M.H.

ANSWER: Yes, to both possibilities. Tell him to stay on his back or side while sleeping for one week, and see what happens.

Scoliosis is an S-shape curve to the backbone. The seriousness of it depends on how great the curve is. If the doctor hasn’t indicated that the curve is at a point where symptoms are expected or treatment is required, then scoliosis is less likely to be the problem.

DEAR DR. DONOHUE: I have black tongue. I was given tablets to put on my tongue, and the black went away but has come back. The tablets didn’t work the second time. I then took a pill that I had to swallow, but it made me sick to my stomach. An ear, nose and throat doctor told me to do nothing and that it would go away. I am worried and unhappy about the situation. Please give me your suggestions about what can be done. – L.M.

ANSWER: Black tongue comes about from elongation of tongue papillae – the tiny projections from the tongue’s surface, some of which have taste buds. Pigment production from mouth bacteria or yeasts adds the black color to the projections. It often happens after taking a course of antibiotics. Most people have no symptoms from it other than the alarming look. Taste isn’t affected.

The ENT doctor’s advice is excellent. Time almost always cures the condition.

You can lightly brush your tongue with a 1 percent or 2 percent concentration of hydrogen peroxide. That hurries the tongue’s return to a normal appearance.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com

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