The videos from the 2026 Milano Cortina Winter Paralympics gave us unforgettable images of athletes competing while seated due to limited mobility in their lower limbs. Those competing in downhill events fly down the slopes on their monoskis, equipped with seats and protected by custom-shaped shells. Those competing in cross-country skiing and biathlon glide on sit-skis attached to two parallel skis, pushing with the strength of their arms and torso, using ski poles.

There is no standard training program for them: Each body, depending on its abilities, has a different “engine” and must develop the correct movement patterns using different muscle groups. “There is a big difference between an athlete with high paraplegia, who has no control of the lower abdominal and back muscles; one with low paraplegia, who can use their core muscles; and an athlete who has had amputations and still retains function in some leg muscles,” explained Paul Marchetti, technical manager and athletic trainer of the National Paralympic Nordic Skiing and Biathlon teams. Everyone trains by strengthening the upper body, not only to ensure an effective push but also to protect the joints from injury. Each person, however, sits differently in the sled to gain stability and uses different muscles for propulsion. A technical error in movement or inappropriate equipment characteristics can damage muscles or tendons. That is why a person with a motor disability who wants to practice a winter sport, even at an amateur level, should consult a technician with specific experience who can supervise them safely and consider their needs.

Sport as a Health Resource

“Participating in sports can provide great physical and psychological benefits for people with lower limb disabilities, improving overall quality of life, reducing the risk of chronic disease, and increasing physical endurance. Sport increases bone density and helps control weight. Psychologically, it helps reduce anxiety and depression, boosts self-esteem, and promotes a sense of emotional well-being,” said Simona Cerulli, physiatrist in the Complex Operational Unit of Sports Traumatology and Joint Surgery at Gemelli Hospital, Rome, Italy. “Studies on athletes with physical disabilities show that regular participation in sports leads to gains in muscular strength, balance, and coordination, as well as positive effects on mental health, such as greater resilience and reduced stress. In addition, for people with amputations or paraplegia, physical activity can improve daily independence and counter social isolation, with lasting effects on psychological health.”

Accessible activities vary depending on the disability. For people with paraplegia, often linked to spinal cord injuries, sports practiced from a seated position that use the upper body are ideal — for example, seated alpine and Nordic skiing, ice hockey, and wheelchair curling — disciplines included in the ongoing Winter Paralympics. Beyond winter sports, there are a variety of activities that do not require the use of the lower limbs, such as wheelchair basketball, volleyball, rugby, tennis, wheelchair fencing and archery, swimming, canoeing, and handcycling.

Amputee athletes, on the other hand, can also take part in disciplines that use prostheses: the sports already mentioned, as well as athletics, horse riding, and climbing, to name a few.

“Anyone interested in exploring the winter sports options available in a safe environment with trained professionals can contact one of the sports clubs affiliated with the Italian Paralympic Winter Sports Federation. The list is available on the federation’s website. Similar federations exist in all countries that take part in the Paralympics and serve as a reference point for athletes with disabilities,” Marchetti advised.

Specialist Medical Support

“In addition to motor limitations, people with lower limb disabilities may have other vulnerabilities,” Cerulli noted. People with paraplegia often have problems with thermoregulation and a higher risk for osteoporosis, pressure sores, or overload injuries to the upper limbs. For those with an amputation, issues can include irritation at the stump site, postural imbalances, joint or low back pain, and fatigue due to higher energy expenditure during movement.

In both cases, these aspects require attention and constant monitoring during sports participation. It is highly recommended, therefore, that anyone who intends to practice a sport with a lower limb disability be followed by a sports medicine physician or a specialist experienced in their condition to prevent injuries and optimize performance. “A multidisciplinary approach that includes physicians, physiotherapists, and coaches is essential to evaluate the interface between athlete and equipment, such as prostheses or wheelchairs, monitor thermoregulation and neurological function, and adapt training programs,” Cerulli concluded.

Marchetti and Cerulli reported having no conflicts of interest related to the topics discussed.

This story has been translated from Univadis Italy, part of the Medscape Professional Network.