Sled hockey is played mainly by people with various lower extremity disabilities (e.g. people with amputations, spinal cord injuries, cerebral palsy, post polio, etc.). The players are seated on sleds, which are affixed to 2 hockey skate blades under the seat. The sleds are about 3 inches off the ice and are from 2-4 feet long, depending on the size of the player. The sled glides on the blades and a metal bar located at the the front of the sled. For beginners the blades can be set wide apart for stability. As skills progress, the blades are placed closer together for better turning ability. There are multiple straps to help to hold the player in and give the player more control over the sled.

Players use their arms to propel themselves along the ice. They dig picks, on the ends of two short hockey sticks, into the ice to pull themselves forward. Players have a right and a left stick (the blades are curved differently) that are miniature copies of a typical hockey stick, except for the metal picks (like figure skate toe picks) on the ends. Players shoot, pass, and propel themselves with the sticks.

There are a few differences between sled hockey and standard ice hockey. Sled hockey games have 15 minute periods instead of 20 and players use two sticks instead of one. The puck is the same, as are the pads. There is a lot of checking so the need for protection is ever present.