Handcycling has become a popular recreational and sporting exercise modality for individuals with lower limb impairments. Literature has focussed on attachable-unit and touring handbikes as a form of mobility and recreation. Conversely, recumbent handcycling is an endurance sport, where athletes compete in time trial (TT) and road race disciplines lasting 20 to 140 minutes. Therefore, despite 20 years of handcycling research, very little is known about recumbent handbike configuration, physiology or biomechanics, which is critical for the development of sports performance.