California—particularly Southern California—is one of the world centers of beach volleyball.

The California Beach Volleyball Association has about 8,000 active members in an array of age and skill divisions scattered over more than 20 locations along the state’s coastline.

Although beach volleyball players less often suffer orthopedic injuries than their counterparts who play on hard surface courts indoors, they aren’t immune. It’s essential to know which injuries are most common among beach volleyball players and how to avoid them to reap the ample benefits of the sport.

The soft sand of a beach volleyball court can help protect players from impact-related injuries. Even so, the unevenness of a sand volleyball court can lead to injury risks related to falls, strains and sprains. And with just two players on a beach volleyball court, versus six on a hard surface court, there is a high volume of repetitive motions and other actions that translate into more body movement.

Most acute (sudden onset) injuries in beach volleyball players are caused by defensive and attack actions. During these movements, players place significant stress on their joints. The most frequent acute injuries involve the ankles, knees and fingers. Together, they account for as many as half of all acute beach volleyball injuries. More specifics about acute injuries:

Ankle Injuries—For beach volleyball players, ankle injuries often result in the greatest loss of playing and training time. They include ankle sprains, although these are less common in beach volleyball than in indoor volleyball. Other common injuries in this category are ankle fractures, lacerations, abrasions to the skin of the ankle and foot (sand toe) and Achilles tendonitis.

Knee Injuries—Patellar tendonitis, also known as jumper’s knee, often occurs in beach volleyball and other sports where the knee is subject to repeated and forceful jumping. It’s characterized by inflammation of the patellar tendon in the knee. Another frequent knee injury is quadriceps tendonitis.

Finger Injuries—Repetitive blocking, setting and digging activities players perform with their hands can lead to finger tendon and ligament injuries, as well as fractures and dislocations of the fingers or wrist.

In addition to acute orthopedic injuries, overuse injuries are widespread. In these cases, damage develops gradually over time and is usually due to too much time repeating the same body motion. Particularly common beach volleyball overuse injuries, according to research, are:

Lower back pain—Pain in the lumbar spine at vertebrae levels L4-5 and L5-S1, spinal disc degeneration and spondylolysis (a spinal stress fracture).

Shoulder pain—Generalized overuse pain among beach volleyball athletes, especially in the striking or spiking shoulder. These overuse shoulder injuries can include infraspinatus muscle atrophy, shoulder tendinopathy, shoulder impingement, labral injuries and tears, rotator cuff inflammation and rotator cuff degeneration.

Read: The Best Stretches and Exercises for Lower Back Pain

As with any other sport at any level, prevention is possible with the proper focus and diligence during training and competition. Here are some important tips:

• Include some training for overall balance, especially because beach volleyball is played on an uneven surface.
• Land jumps appropriately, with knees positioned over the toes.
• Performing lunges, squats and glute bridges can help to strengthen leg muscles and aid in avoiding knee injuries.
• Always execute proper technique and prevent overuse from repetitive movements.
• External rotation and arm reach exercises can help strengthen the shoulder.
• Consider patellar tendon straps, which can help unload stress on the tendon.
• Physical therapy and area-specific athletic training can also help in preventing beach volleyball and other sports-related injuries.

Combining these practices with a regular fitness routine can have a big payoff in injury prevention. By following these steps, beach volleyball players can fulfill their dreams of spending more time competing on the sand instead of recovering on the couch.