When Dr. Matt Roller played football, a concussion on the field typically prompted laughter-not worry nor concern-from teammates.

"Prior to the culture coming around about the seriousness of concussions in the last 10 years or so, concussions were regarded as funny," said Roller, a neurologist at Altru.

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"It was 'getting your bell rung' and there was giggling by teammates as a player wobbled woozy to the sidelines. Now we have learned more and more over time that recurring concussions can have some pretty serious medical consequences."

The neurologist doesn't see football-nor wrestling and hockey, other sports with concussion issues-as the enemy as the North Dakota and Minnesota playoffs are now underway. After being an all-stater in football at Devils Lake High, he played for North Dakota State. He had the reputation of being a hard-nosed player who'd do the physical, so-called dirty work in the so-called trenches where collisions occurred. And, he has sons in eighth and sixth grades who are playing organized tackle football, with parental consent.

Roller said he is not against the sport, but is against the potential consequences. His emphasis is on the dangers of concussions, especially any that occur after the first one.

"We know that the higher the number of concussions, the greater the potential for lifetime consequences for that person," he said.

"When you go from one concussion to two, it's recurrent and a recurrent concussion is much more significant than the first one. If you've had one concussion, it becomes more easy to have subsequent concussions."

He doesn't directly say that two concussions should end a career in contact sports; but he strongly hints at it: "The rules change when concussions become multiple," he said. "Anyone who has had two concussions and still wants to play, I urge everyone to evaluate how important it is to keep participating. When there have been two serious concussions, the parents and doctors need to talk.

"Dealing with the consequences of concussions is a significant portion of my practice."

Mom/son negotiate sports

Marcus Niemann, a junior at Grafton High School, has experienced three concussions-in baseball in July 2014, basketball in January of 2015 and football in the fall of 2015.

Mother Jaci Niemann said two of the concussions were classified as minor and one as major. "We're encouraged that it's been more than a year since his last concussion," she said.

Marcus is a top-shelf athlete, having been named to the all-region team in all three sports as a sophomore, a rare feat. In this fall's football season, the junior wore a special, heavily padded helmet and had no troubles.

He said he can't envision being without sports.

Jaci said one of his three concussions was regarded as "major" by health professionals while the other two were deemed as "minor." A school employee, she's said she's confident that coaches, doctors, trainers and others have her son under thorough scrutiny for reaching baselines that need to be reached. And, she is comforted that the North Dakota State High School Activities Association-like most other states-requires clearance from a medical professional before any concussed athlete can return to play.

And, she has a promise from her son that he will reveal any symptoms.

"Most of the questions are about memory and you have to take the mental and physical tests and do it without getting a headache afterwards," Jaci said.

Marcus said his concussions "tired me out, made my stomach feel empty and gave me throbbing headaches."

But, he says he hasn't experienced any aftereffects in the past year.

The response from his peers is mixed. "Some say it's not worth it to take the risk," Marcus said. "But I can't imagine life without sports."

NDHSAA takes precautions

For almost a decade, the North Dakota High School Activities Association has required clearance by a medical professional to allow concussed athletes back to their sports. It's the same in Minnesota and most of the other states.

"And a lot of our schools have been very proactive by using baseline testing," said Justin Fletschock, an assistant director at NDHSAA. "They can use that as a measuring device for returning back to normal.

"Concussion rates are dropping nationwide, with the big reason being because we have been proactive. Twenty years ago, you'd never even think about concussions."

The NDHSAA, like some other state organizations, also limits the number of contact practices. North Dakota allows a maximum of four contact practices a week during the preseason and two practices a week during the season. Contact practices are defined as going full speed while wearing all of the equipment.

Football is the most common sport for concussions, followed by wrestling and hockey. All game officials and coaches in grades 9-12 are required to take a concussion course every two years.

Fewer players?

It's unclear if the publicity about concussions has lowered the participation in football in Minnesota and North Dakota.

According to National Federation of State High School Association numbers, football participation in North Dakota has gone from 4,100 in 2012 to 4,092 in 2013 to 3,893 in 2014 and 4,025 in 2015.

In Minnesota, football participation has slowly declined from 26,553 in 2013 to 26,484 in 2013 to 25,690 in 2014 to 25,640 in 2015.