BACKGROUND: Chronic Achilles tendinopathy is characterized by persistent pain, swelling, and functional limitations, particularly in overweight middle-aged women. This demographic is predisposed to tendon degeneration due to biomechanical overload and hormonal fluctuations. OBJECTIVE: This study aimed to compare the effectiveness of an aquatic neuromuscular exercise programversus a conventional land-based exercise program in overweight middle-aged women with chronic Achilles tendinopathy, using pain intensity (visual analogue scale), ankle dorsiflexion range of motion (weight-bearing lunge test, WBLT), and functional performance (patient-specific functional scale, PSFS). METHODS: A randomized controlled study was conducted on 102 overweight women aged 40 to 50 years (body mass index 25 to 29.9 kg/m2), clinically diagnosed with chronic Achilles tendinopathy. Participants were randomly assigned to Group A (aquatic neuromuscular program) or Group B (conventional exercise therapy). Both groups underwent supervised exercise sessions four times weekly for four weeks, with progressive intensity. Outcome measures included the visual analog scale for pain, the WBLT for ankle dorsiflexion, and the PSFS. Data were analyzed using paired and unpaired t-tests. Mean differences, standard deviations, p values, and effect sizes were reported. RESULTS: Group A showed superior improvements across all outcome measures. Pain during activity reduced from 5.96 +/- 1.26 to 1.36 +/- 0.88 (effect size 4.23), dorsiflexion improved from 15.24 +/- 1.47degree to 27.34 +/- 1.77degree (effect size 7.44), and PSFS scores improved from 15.21 +/- 2.86 to 28.65 +/- 2.74 (effect size 4.80). Group B showed statistically significant but comparatively smaller gains. Statistical significance (p < 0.0001) was observed in all outcomes. CONCLUSION: This four-week aquatic neuromuscular exercise program proved superior to conventional exercises in reducing pain, improving ankle dorsiflexion, and enhancing functional performance in overweight middle-aged women with chronic Achilles tendinopathy. These findings support the use of aquatic-based neuromuscular rehabilitation as a clinically beneficial and low-impact intervention for this population.

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