Abstract
Background/Objectives: Sport participation provides important physical and psychological benefits but carries a risk of musculoskeletal injury and associated pain. In adolescents with lower-limb disabilities, sport-related pain may exert a distinct influence on quality of life, coping strategies, and ongoing engagement in physical activity. This study examines these effects in sitwake training participants, comparing adolescents who experienced transient injuries during training with those who did not, and evaluates subsequent changes in pain attitudes, quality of life, and return-to-sport rates. Method: A prospective case-control study was conducted over three months, with baseline and follow-up assessments. Adolescents with lower-limb disabilities engaged in sitwake training were assigned to a pain group (PG: with transient injuries with moderate pain during the observation period) or a no-pain group (no-PG). Health-related quality of life and pain attitudes were measured using the 37-item DISABKIDS Chronic Generic Module and the 27-item Pain Attitudes Questionnaire. Injuries in PG were managed with physiotherapy. Return-to-training rates were recorded the following season. Results: At baseline, the PG and no-PG showed comparable scores in the two scales. By follow-up, the PG demonstrated significantly greater improvements in independence, physical limitations, emotions, social inclusion, stoicism, and cautiousness subscales (all inter-group change score differences: p ≤ 0.001). No differences were observed for social exclusion (p = 0.229) or treatment impact (p = 0.986) subscales. Return to training rates were higher in the PG (65%) than no-PG (29%). Conclusions: Sitwake training participation with transient, moderate pain promotes positive psychosocial outcomes in adolescents with lower-limb disabilities. The PG showed greater improvements in quality of life and adaptive pain attitudes, with higher return-to-training rates. Structured, manageable sport-related pain may facilitate resilience, coping, and sustained engagement in sport.