Background: The aim of this study is to examine the rates of sports related injuries in adolescents based on the severity of their long-term illnesses or disabilities (LTID). Few injury prevention strategies in sports and health promotion have explored disaggregation by disability. Methods: Data obtained from the 2014 Finnish Health Behaviour in School-aged Children survey (n = 3716, mean age = 14.8, SD = 1.03) were grouped into adolescents with and without LTID. A further indicator or severity was determined when adolescents reported their LTID affected their participation (affected LTID). Odds ratio (95% CI) were used to determine the associations between sports related injuries and LTID, daily moderate to vigorous physical activities (MVPA), being a sports club member, physical competence, and family encouragement, after controlling for age, gender and family affluence. Results: One in four adolescents (25%) reported to have LTID and one in eight adolescents (12.5%) reported sports injuries. The odds for adolescents with chronic conditions, functional and learning difficulties was the highest (OR 3. 55, CI = 2.3–5.4) for overall injuries, when compared with adolescents without LTID. Adolescents with affected LTID (OR = 2.08, CI = 1.5–2.9) were more likely to report medically attended injuries than adolescents without LTID. Sports-related injuries (OR = 0.33, CI = 0.1–0.8) were lower in adolescents with affected LTID than those without LTID after adjusting for personal and environmental factors. Conclusions: Taking part in sport clubs increases the risk of sports related injuries in adolescents with and without LTID, but not with affected LTID. Few adolescents with affected LTID participate in sports clubs and were less likely to report the most serious type of injury to be from sports. These results could be used for devising sports based injury prevention and health promotion strategies for children with LTID.