Contemporary Advances (2015–2026) in Extracorporeal Electromagnetic Transduction Therapy and Pulsed Electromagnetic Fields for Musculoskeletal Disorders: A Systematic Review of Dosimetry and Clinical Response

Background and Objective: Pulsed electromagnetic fields (PEMF) and extracorporeal magnetotransduction therapy (EMTT) have shown promising results in various musculoskeletal disorders; however, substantial heterogeneity in application parameters has hindered the establishment of clear relationships between electromagnetic dosing and clinical response. This systematic review aims to evaluate the safety and effectiveness of PEMF and EMTT therapies for treating chronic musculoskeletal injuries in adults, based on research from 2015 to 2026. By analyzing how specific dosage parameters (such as intensity, frequency, and duration) influence clinical results, the study seeks to establish standardized, evidence-based guidelines for electromagnetic treatment prescriptions. Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines and prospectively registered in PROSPERO (CRD420251059359). A comprehensive search was performed in PubMed/MEDLINE, CENTRAL, and ScienceDirect for the 2015–2025 period. Randomized clinical trials, quasi-experimental studies, and case reports were included. Study selection, data extraction, and risk of bias assessment were performed by two independent reviewers using RoB 2, ROBINS-I, and Joanna Briggs Institute checklists. Results were synthesized narratively following SWiM (Synthesis Without Meta-analysis) recommendations. Results: Twenty-eight studies (1060 participants) were included. A dosimetric dichotomy emerged: high-intensity protocols with rapid field variation rates (e.g., EMTT > 60 kT/s) were consistently associated with robust improvements in structural and mechanically driven pathologies. Conversely, low-intensity protocols (e.g., <5 mT) often yielded results indistinguishable from placebo or active controls, particularly in nociplastic pain conditions. Quantitative analysis indicated that in structural pathologies, functional gains were maintained or amplified post-treatment, whereas nociplastic conditions showed potential symptom recurrence. No serious adverse events were reported, confirming a favorable safety profile. Conclusions: PEMF and EMTT are promising adjunctive therapies for musculoskeletal disorders, with efficacy appearing sensitive to electromagnetic dosimetry. However, significant methodological heterogeneity and the use of combination therapies limit these findings to exploratory trends. The lack of standardized safety reporting and technical parameters (e.g., waveform, dB/dt) underscores a critical translational gap. Future research must prioritize rigorous, standardized randomized controlled trials to establish definitive, evidence-based therapeutic recommendations.