With eye-watering collisions and no prisoners taken, the sport got underway at the Paralympics on Wednesday with the United States, gold medal favourites and the world's top-ranked team, overcoming a valiant effort from Britain for a 56-44 win in the eight-team event.
Invented in 1977 by a group of Canadian quadriplegic athletes seeking an alternative to wheelchair basketball, wheelchair rugby has two teams of four players attempting to carry the ball over a goalline.
Physical contact is not allowed but contact between wheelchairs is. It is not for the faint-hearted, and perhaps the most telling fact is that most of the Olympic teams have a welder among their support staff to put the players' chairs back together after a match.
"We all weigh differently -- our players weigh anything from 120 to 220/240 pounds, and our chairs are another 40 pounds on top of that," U.S. captain Will Groulx told Reuters after his side had overhauled a first-quarter deficit.
"So it's like 200-pound sledgehammers coming in at full speed, 17-18 mph and just blowing each other up. But it's a lot of fun. It's a blast. It shakes your insides when it happens but we wouldn't be out here if we didn't love it."
Games consist of four eight-minute quarters and players use a white ball identical in size and shape to a volleyball.
Each players is assigned a points value (0.5 to 3.5) based on their impairment. During play, the total on-court point value for each team of four players cannot exceed eight.
The aim is to carry the ball over your opponent's goalline, and a team gets 40 seconds to attempt to score a point and 10 seconds in an opponent's key area.
Players also use wheelchairs specifically designed for the sport. Features include a front bumper, designed to help strike and hold opposing wheelchairs, and wings, which are positioned in front of the main wheels to make the wheelchair more difficult to stop and hold.
Like in most sports, pace is key. But so is teamwork.
"We have a lot of great individual athletes on our team and when we come together that's what makes us successful," said Groulx, renowned for his speed and regarded as one of the best players in the world.
The US won Paralympic gold in 2000 and 2008 but should be tested in London by Australia and Canada.
The basketball arena was filled almost to capacity on Wednesday in what Groulx said was the biggest crowd he had played in front of.
"Having 12,000 fans cheering was amazing, whether they were cheering for us or Britain you can't help but raise your intensity level. Beijing (in 2008) was a big crowd but this tops them all," he said.
The fervent home support did their best to lift the hosts, who led 13-11 after the first quarter. Too many turnovers proved costly, however, as the US forged ahead at 18-17 and never relinquished their lead.
Britain, searching for a first Paralympic wheelchair rugby medal after fourth place in 2004 and 2008, have in Aaron Phipps a player that could carry the hosts a long way in the tournament.
A quick and talented ball carrier, Phipps took up the game only in 2009 and is a potent weapon in attack. One defensive block to deny a score on Wednesday earned the crowd's roar of approval.
Phipps, who top-scored in the match with 16 goals, also showed he was not afraid to mix it, earning a three-minute penalty for a flagrant foul in the third quarter for taking out Groulx.
"I was so nervous in the tunnel (before the game). I played quite well when I was on court, but the USA are so clinical with the ball, they were always going to be hard," he said.
Wheelchair rugby is a mixed sport, and in Kylie Grimes Britain have one of two female players in the event. The other is Belgium's Bieke Ketelbuters.
Grimes, paralysed from the chest down after hitting her head diving into a friend's swimming pool, said she does not notice the gender difference.
"I don't know any other way," she said. "Girls do come along and have a go. But maybe they're deterred by the fact that there's mainly men there and it's clearly an aggressive sport."