Only a surfer knows the feeling - of getting sliced by a fin or whacked in the face by the nose of their board.
Now, researchers are working to make the iconic Aussie sport safer by looking at the link between surfing injuries and developments in board and accessory design.
The research, presented at a radiology conference in Sydney, has found that head and neck damage account for about one-third of all surfing injuries.
Royal North Shore Hospital specialist Dr Simon Dimmick has studied the injuries of surfers admitted to the hospital over the past two years.
"Most spinal injuries involve the neck and the majority are caused by surfers being dumped and coming into contact with the sea floor," he said.
"However the majority of head and facial injuries are caused by surfers being hit with their own surfboards."
Dr Dimmick said the types of injuries had changed over time due to innovations in board design.
"The last crop of studies into surfing injuries was done in the mid-80s; since then boards have changed greatly. They are shorter, lighter and more manoeuvrable," he said.
"Gone are the days of surfers standing on a longboard and riding in to shore on a wave - these days surfers are doing all kinds of manoeuvres including aerials and 360s.
"As a result there's more knee and ankle injuries, and there's a lot more chance of getting whacked in the face by the board."
Gerringong custom board designer Jade Robinson has suffered a few surfing injuries himself, once requiring stitches after being hit in the head by the fins of his board.
Mr Robinson's father Paul started a surfboard business in the 1970s and he followed suit 15 years ago with DSN Surfboards.
"I always advise beginners to start off on a soft board - made of a soft foam deck and with rails - and use rubber or safety fins," he said.
"There's also other accessories like rubberised nose guards and surfing helmets which help protect from injury."
Dr Dimmick said the sport was still relatively safe, with the incidence of injury ranging between 2.2 and 3.5 injuries per 1000 hours of surfing.
However, he said, more than two million Australians surfed so injury prevention was vital. Royal North Shore, Mona Vale and Manly hospitals were recording surfers' injuries.
"We need to continue to look at what predisposes surfers to injury to develop appropriate health and safety warnings and to contribute to the development of new safety accessories."