Sean Ingle is right to mention the benefits of rugby but, as he suggests, there is a balance to be found in weighing up the associated risks of contact sport to a developing brain (Should U18 rugby be banned? No. But tell that to parents of a concussed child, 5 February). Concussions in the adolescent age group present a unique challenge, particularly given the wide-ranging nature and duration of symptoms. Interestingly, those seen in our complex case clinics often demonstrate a significant psychological involvement in their prolonged concussion symptoms, in many cases stemming from concerns about long-term cognitive impairment. In spite of this, we cannot shy away from the issue with young people and their parents; we must be honest about what we know about the risks of single or repeated concussions, and what we do not yet know. Evidence suggests that in terms of long-term risks of brain damage, repeated “sub‑concussive” head impacts and years of play are potentially of more significance, but that doesn’t mean that identification and effective management of potential concussions isn’t hugely important in both the grassroots and professional game. Contact sports will never be completely without risk, but having witnessed the willingness with which the schools and clubs we work with have embraced the importance of managing the risks of head injuries and concussions, the future of rugby isn’t perhaps as bleak as some suggest. Dr Mike Forsythe Deputy head of sports medicine, Return2Play