Medicine Ball Training: Planning, Progression and Implementation. By Eamonn Flanagan & Cedric Unholz

Eamonn Flanagan & Cedric Unholz

An introduction to medicine ball training

Medicine ball work is a popular training modality with a long documented history in physical preparation. Throws and their variants are widely used in Track & Field and other sports performance settings to help target a range of physical qualities, offering training options and variable loading parameters for youth athletes to elite-level performers.

The affordability of medicine balls make them a popular choice for athletic preparation, and their versatility allows practitioners to target a large range of developmental demands. Sophisticated use of medicine ball work should follow the same principles as other general training; namely gradual and appropriate progression of intensity, volume and exercise selection over time to match the needs of the athlete.

A number of considerations are necessary to achieve this, particularly understanding an athlete’s training history and current developmental level. Depending on exercise choice, medicine balls may be used to impose a high level of neural, musculoskeletal, and/or cardio-respiratory stress to a system. The coach must be conscious of both the desired and actual effect of what is being prescribed; is the athlete equipped to tolerate and perform what is programmed? Intensity can be relative to preparation level - what is ‘low intensity’ for one athlete may be ‘high intensity’ for another. This has large implications for training design between different individuals.

As effective as medicine ball training can be, it is vital to appreciate that it’s different forms exist along the general training spectrum. As such, there is significant overlap with work performed in other training modalities such as plyometrics, general strength work and weightlifting. In many instances, these may actually offer a more efficient stimulus depending on the training goal. The coach must therefore use sound coaching judgment to discern which is the right tool for the desired outcome, and identify what balance between the various options is appropriate.

Medicine ball work is traditionally organized into two general categories - extensive and intensive.

Extensive efforts are often performed in circuit-style fashion, and predominantly aim to develop circulatory systems and general conditioning qualities. When working with youth athletes, extensive work can also serve as an appropriate way to teach fundamental movements, along with gradually introducing ‘formal’ training loading processes and force generation demands. In addition, extensive medicine ball work is an effective way to help facilitate body-composition and hypertrophy goals, especially in younger or deconditioned adult athletes.

Intensive work consists of exercises incorporating a maximal ballistic/plyometric action prior to, or at the point of, releasing the ball. Common examples of this are various types of explosive throws, which can be performed in multiple planes and allow for high threshold outputs during rotational and triple extension efforts. In addition, intensive medicine ball variants are highly useful for speed development purposes, as they can be implemented in a variety of ways to facilitate appropriate acceleration and force application mechanics. Traditionally intensive movements are classified within a single grouping. However, it can be useful to distinguish between work done consisting of stand-alone intensive throws, and those combined with higher intensity activities such as preceding jumps or subsequent accelerations. These efforts can be termed as “complex-elastic” pairings, and generate significantly higher absolute mechanical outputs, as well as a greater cumulative stimulus within each repetition sequence when compared to single throws alone. Furthermore, these combinations impose a large amount of musculoskeletal stress and a high degree of coordinative demand. As such, great care must be given to appropriate exercise selection, recovery periods, and timing of prescription relative to an athlete’s preparedness.

Structuring and progressing medicine ball training

A vital component of a successful training process is the intelligent manipulation and application of loading parameters over time. Intensity, volume, and frequency of execution are all important factors to consider within a general planning framework, as well as how these variables interact with and impact on training/competition demands.

Gradual and logically sequenced progression models are valuable tools to support this. These provide practitioners with a general outline to aid thoughtful, appropriate training selection and allow a smooth transition through various training stages. The determination of advancement is based on the athlete’s rate of development, as well as a coach’s observation of individual strengths, weaknesses, and needs. This allows the progressive improvement of relevant physical qualities over the course of multiple training cycles. In addition, these considerations assist to ensure an athlete is working within their current capabilities, which plays a substantial role in allowing the body’s structures to respond appropriately to training stimuli and reduces injury risk.

In order to construct a suitable exercise progression template, a number of variables need to be considered. Mechanical outputs, skill requirements and postural demands inherent to a particular movement are all crucial components that guide the placement of an exercise within a progression spectrum. There is a large amount of overlap that exists along these continuums, meaning that creating an ‘optimal’ model is rarely possible. A more reasonable approach is to evaluate which variables and base principles are important to a particular situation or athlete group, and use these to help guide the construction of a general model that is in line with the practitioner’s overall training philosophy. 

In the case of medicine ball training, an example of this could be to order exercises and progressions based on a combination of mechanical output, as well as movement demands. Using this taxonomy and depending on the training goals, intensifying medicine ball work can be accomplished by manipulating any of the following “intensification variables”:

  1. Increasing the skill complexity of the movement
  2. Using a heavier medicine ball
  3. Performing a movement in a more challenging biomechanical position
  4. Increasing movement speeds and/or intent of effort
  5. Combining throws with an additional higher intensity task such as an acceleration or jump

Intensity is a general term and doesn’t differentiate between the relative load on physiological systems within the body. Jovanovic and Flanagan (2014) previously described intensity as three intensity types: intensity of load, intensity of effort and exertional intensity. 

In medicine ball training, the intensity of load is increased by simply using a heavier ball. Intensity of effort is increased by athletes raising their intent to perform repetitions with maximal possible acceleration and speed. Exertional intensity is related to the proximity of failure in a given set. Increasing rep or session density raises the relative exertional intensity of an exercise or training session. 

The interaction between these three intensity types will govern the overall output from any exercise and the magnitude of work completed relative to the athlete’s capacity in a particular physical quality across strength, power or speed. This has implications for training load and athlete management.

Manipulation of one intensification variable may shift the training emphasis from one physiological system or training goal to another. For example, performing an exercise in a more demanding position (a lunge with low rear knee vs. a ½ kneeling position) may actually reduce neuromuscular fatigue but increase musculoskeletal demands. Utilising a heavier medicine ball may increase the intensity of load but can have undesired effects on movement speed or quality. When constructing medicine ball training plans, coaches should consider how manipulation of “intensification variables” and “intensity type” impact on the overall training output and physiological systems of the body including:

  • Neuromuscular – what is the challenge to the nervous system?
  • Musculoskeletal – what is the mechanical load on the body? 
  • Cardio-respiratory – what is the cardiovascular demand?

Following these parameters, and building on the aforementioned differentiation between extensive and intensive orientated work, a large amount of progression combinations exist. The anatomical movement planes of the body may help to further distill this classification process and enable the practitioner to have a solid progression overview, as an almost infinite amount of exercise options exist within this area. 

Extensive exercises are typically low impact and performed with more controlled, sub-maximal ball speeds. Foundational movements in all planes of motions may be implemented, and positional constraints can be used to limit intensity of effort, accommodate lower physical developmental levels, and encourage desired movement patterns. There is an abundant array of exercises possible within this category. Our progression model below provides example body positions from which throws, slams and other non-ballistic range of motion exercises can be performed. Within this category, work is typically intensified by increasing the intensity of load, the exertional intensity or by using more challenging biomechanical positions which in turn ramps up musculoskeletal and cardio-respiratory demands. 

From the extensive to intensive phase, both the intensity of effort and overall exercise output are increased. This likely increases neuromuscular load with exercises becoming more ballistic in nature resulting in higher ball and limb velocities. Within the intensive category, positional constraints can be loosened to allow greater ranges of motion and augment neuromuscular outputs. For example, throws performed in standing will allow for greater overall intensity of effort than those performed in kneeling or supine lying positions. 

Tasks in the complex-elastic category produce the highest forces, velocities, and neuromuscular outputs due to the nature of the actions being performed and combined. Positional constraints are imposed by the types of throws, jumps and/or acceleration start positions chosen. A variety of movements can be integrated to achieve a multitude of outcomes, such as targeting starting strength qualities and facilitating appropriate mechanics. An illustration of this would be to pair a chest throw from a crouched posiiton with an immediate acceleration. In this example, the chest throw reinforces and develops the force application profiles relevant to the subsequent acceleration, and helps put the athlete in an advantageous postural position from which to initiate the sprint. Exercises in this phase create high neuromuscular and musculoskeletal loads, and therefore careful attention must be paid to recovery times both within, and between, sessions. 

A common approach to medicine ball development is to advance from extensive, to intensive, and finally to complex-elastic work over the course of successive training cycles. While this base model satisfies the progressive element necessary in a sophisticated training system, strictly moving from one phase to the next may be overly simplistic. Instead, a more refined approach is to use this base model as a general ‘road map’ to indicate direction of development over time, but to also include elements of all phases within each stage of training. This can be achieved by thoughtfully altering the relative emphasis placed on each category in a given cycle depending on training goals. The result is what Charlie Francis termed a ‘vertically integrated’ approach that allows smooth transitions between phases, helps prevent the decay of previously trained qualities, and limits acclimatization time with new training demands

Quantifying medicine ball training

Despite the prevalence and obvious application of medicine ball training, empirical research of training interventions is scarce. A search of the NSCA’s archives shows only 16 articles ever published in the Journal of Strength and Conditioning Research with “Medicine Ball” in the title, with only 6 of these studies utilizing a medicine ball training intervention. One possible reason for this is that medicine ball training intensity has not been precisely measurable. While we can count reps and sets, the adaptation driven by medicine ball training is hugely dependent on the intensity of effort, especially in intensive and complex-elastic phases of training. Until recently this has been difficult to quantify. While it is easy to express the load on a barbell as a convenient percentage of 1RM, it is much more difficult to define the intensity of effort on medicine ball throws or slams. How do we know if the athlete is working at true maximal intent of effort and how do we quantify the overall training output?

The mindful intention to execute ballistic exercises with high effort is highly important to drive training adaptation. Optimal training adaptation will occur where “velocity specific” tasks are combined with high intensities of effort. Athletes must approach intensive or complex-elastic medicine ball training with a high level of intent to produce maximal outputs from rep-to-rep.

It is useful for coaches to provide athletes with augmented feedback in ballistic exercises to promote intent in appropriate training phases. Task-intrinsic feedback is feedback that we “feel” or “see” naturally as we perform the skill. However, augmented feedback boosts intrinsic feedback with specific “knowledge of performance” that we couldn’t detect ourselves. Training studies have shown that augmented feedback enhances training performance and adaptation in ballistic exercises. Feedback on peak velocities in jump squat training increases the velocities achieved in training and improves transfer of training to speed abilities (Randell, 2011). Feedback on jump height in plyometric drop jumps enhances performance within sessions and drives greater long term training adaptation (Keller, 2014). 

It’s common sense: Measure it, feed it back, and we get heightened intent of effort from our athletes. If we want to stimulate maximal focus of attention and maximal output in power development tasks, we need to set goals, challenge athletes and motivate them to perform. Technology can play a role here. 

With the increasing availability of instrumented medicine balls and wearable inertial sensors, measuring medicine ball training intensity is now within the reach of almost every coach and athlete. Wearable accelerometers such as the Push band allow for the measurement of velocity in a range of medicine ball exercises such as slams, standing and lying throws, vertical tosses and rotational throws.

This is an important step forward for the measurement and optimization of medicine ball training. Quantifying jump height and ground contact times allows for the refinement of our plyometric practices. Assessment of bar velocity helps inform our strength training program. And now determining outputs in our throws, tosses and slams can help to ensure we improve our medicine ball training. Peak velocity is the key performance metric, and is achieved right at the moment of release in a throw. This output along with the height and angle of release directly determines how far the medicine ball will be displaced. If we can measure peak velocity from rep-to-rep in a reliable and valid way, a number of practical training applications become available to us:

1) Ensure consistent maintenance of sub-maximal velocity across sets in extensive training phases.

In extensive training, the training goal is typically movement quality and consistency over output. Velocity monitoring from rep to rep can be used to “limit” athletes’ output from rep-to-rep and to encourage consistency across sets. The graphic below demonstrates an example “10 throw” test protocol where the athlete is targeted to achieve a particular sub-maximal peak velocity across 10 throws with feedback after each repetition. 

2) Encourage high rep-to-rep velocities during intensive medicine ball training
In intensive training phases the training focus shifts to higher intensity of both effort and relative outputs. Measurement across reps and from session-to-session can help motivate athletes to perform maximally, and will create competition within and between athletes. 

3) Compare velocity “output” across exercise selection
Velocity measurement offers the coach the unique opportunity to trial different exercises and body positions to assess the effect on peak velocity. The graphic below demonstrates the difference in peak velocity between supine lying chest throws, half-kneeling chest throws and standing chest throws with a power step into the ball release. It is easy for the coach to assess the effect of positional constraints on exercise outcome. 

4) Apply velocity stop percentages to adjust repetition ranges in intensive training phases
With limited scientific literature available on medicine ball training prescription, coaches may need to be agile with their rep and set protocols. Lessons can be learned from velocity based strength training where “velocity stops” can be used to ensure all reps are within a particular percentage of maximum. In these phases a “less is more” approach can reap dividends if we ensure high outputs on every rep. 

In closing…

Medicine ball training can have a myriad of positive training effects ranging across improving cardio-respiratory fitness, muscular endurance, fundamental movement skills and speed/power qualities. While medicine ball training is widely used, there is little published, empirical evidence to guide coaches who wish to be precise in its implementation. However, a logical, thoughtful approach to understanding the demands of medicine ball training and its effect on the body can be taken to help refine medicine ball training program design. 

Coaches must consider the level of the athlete and their training goals as a starting point. From there, intensification variables such as body position, movement speed and task complexity can be manipulated to achieve desired outcomes with mindfulness being paid to the type of intensity being performed, and its physiological effects on the body. Technology can support this with clear applications that help motivate, measure and monitor medicine ball training, and therefore assist coaches in assessing the direct effects of their training prescriptions. 


Eamonn Flanagan, PhD.
Eamonn is the lead strength and conditioning consultant with the Sport Ireland Institute where he manages the S&C delivery to Ireland’s Olympic and Paralympic athletes. He has previously worked in professional rugby with the Scottish Rugby Union, Edinburgh Rugby and The Irish Rugby Football Union.

Cedric Unholz
Cedric is a S&C Coach with the Buffalo Sabres (NHL) and Rochester Americans (AHL). He has previously worked in Ireland as the lead S&C coach for Munster Rugby's Academy, in the NCAA at Simon Fraser University (Canada) and in professional/international rugby with the Scottish Rugby Union.