Background Successful performance in Paralympic Games (PGs) requires continuous monitoring of the athletes’ health and optimal medical care.

Objective To present the health status and disability category of Polish athletes at the Beijing and London PGs, as well as to compare the injuries and illnesses incurred during both PGs in view of the more stringent healthcare guidelines implemented before London.

Methods The preparticipation examination (PPE) involved general medical/orthopaedic examination, ECG, blood and urine tests. The mandatory periodic health evaluation (PHE) introduced before London comprised general medical/orthopaedic/dental examination, anthropometric measurement, ECG, stress test, laryngological and ophthalmological consultations, and blood and urine tests. The incidence rate (IR) for all injuries/illnesses with 95% CI, incidence proportion and exposure data (athlete-days) were calculated.

Results There were 91 Polish Paralympians in Beijing and 100 in London. Medical consultations decreased from 151 to 74 (injuries: 57 vs 24 and illnesses: 94 vs 50). In both PGs, respiratory tract infections (RTIs) were the most frequent: IR increased from 15.2 in Beijing to 18.1 in London/1000 athlete-days (95% CI 9.7 to 20.7 vs 11.5 to 24.7). In both PGs, most injuries/illnesses concerned Paralympians with spinal cord injuries. The PPE before both PGs confirmed the disability type according to the general medical classification and revealed no health-related contraindications. Only 6.6% of athletes before Beijing but 100% before London had undergone the multispecialist PHE.

Conclusions In both PGs, illnesses were more frequent than injuries. RTIs presented a serious problem. Some groups of disabled athletes are at an increased risk of injury/illness. The more stringent medical care guidelines before London may have caused staggeringly better results.