International competitions for the wheelchair-confined are now a major feature of the world of sport. They are helpful in improving both mood state and physiological function, while improving long term prognosis. Immediate medical problems are much as in other types of competition, but there are also specific problems (bladder infections, pressure sores, intolerance of environmental extremes, and injuries related to wheelchair use). Disability classification, based on the anatomical or functional level of a lesion, provides a reasonably fair basis for competition. Most of the functional data to date relate to strength (isometric and isokinetic) and aerobic power (measured in a wheelchair or on an arm ergometer). While the inactive patient is often severely limited, wheelchair athletes may have a greater functional capacity than sedentary normals. The principles of training for the wheelchair-confined are much as in the able-bodied, although because the arm muscles are small, much of the training response may be peripheral rather than central. The margin between an effective stimulus and overtraining is also reduced. Involvement in a training programme not only increases physiological function, but also counters depression, increasing the subject's sense of self-efficacy. Biomechanicians are now contributing increasingly to wheelchair sport, improving the design of competitive wheelchairs, improving the mechanical efficiency of participants, and helping to reduce the risks of injury. The benefits of wheelchair sport are now clearly established, and family physicians should do more to encourage the involvement of the wheelchair-confined.