INTRODUCTION:

The most prevalent rheumatologic condition, osteoarthritis (OA), is a serious health issue that commonly results in pain in middle-aged and older persons. Although there is currently no approved treatment for osteoarthritis (OA), there are a number of pharmacological and non-pharmacological therapeutic techniques that have been used to manage pain. Actions can be done to reduce functional level, improve joint motion, and maintain joint health.^1,2. The incidence rate of osteoarthritis (OA) of the knee in India is significant, reflecting both the aging population and lifestyle factors, Different factors such as age, sex, heredity, and lifestyle can affect the incidence rate.

Studies suggest that OA knee prevalence in India ranges from 22% to 39% among the adult population, with higher rates in women and older individuals^14,15. Pulsed electromagnetic field therapy, or PEMF, has been shown to be a good therapeutic option for a number of diseases relating to bones and cartilage during the past thirty years.Its effects above a placebo are yet unknown^1,3. PEMF creates tiny electrical fields in tissue by using electromagnetic fields.³, to create a thermal effect that promotes tissue repair and reduces discomfort and inflammation¹. PEMF treatment for OA has been recommended in several recent articles^2,4-7, and the European League Against Rheumatology has categorized PEMF therapy as 1B of evidence for OA with B rating for level of recommendation³. The transduction signals that encourage the production of new bone may be mediated by piezoelectric potentials generated by PEMF; a comparable process occurs in cartilage, where chondrocytes are stimulated to produce more proteoglycan⁸. PEMF promotes chondrogenic development and the extracellular synthesis of type II collagen and aggrecan in cartilage⁹.This study set out to determine whether PEMF could complement the traditional physical therapy for osteoarthritis in the knee, which included hot packs, therapeutic ultrasounds, and terminal isometric exercises.

Many people, particularly the elderly, are impacted by OA, which can cause pain and interfere with daily activities¹. The most prevalent kind of joint disease², knee OA is the main source of pain and impairments to physicalfunction in middle –age and older³. For pain management, many patients are resorting to non-pharmacological therapy to prevent the negative consequences of chronically taking conventional drugs⁴. Numerous non-pharmacological treatments for osteoarthritis (OA) are varying in their phases of research, development, and implementation. Patient with osteoarthritis (OA) of the knee require conservative and efficient methods of pain relief; pulsed electromagnetic fields (PEMF) are one such method that is showing promise. PEMF therapy has been shown in vitro to be beneficial in influencing cartilage homeostasis⁶, also in reducing MMP-13 production in the knee cartilage of ovariectomized mice and chondrocyte death⁵. However, results from human studies are inconsistent^7-9, indicating that additional research utilizing various electromagnetic device types, treatment regimens, and patient groups is necessary to validate the effectiveness of PEMF therapy in OA. PEMF therapy has been shown to be successful in lowering pain and improving function in trials using high-quality methodology¹⁰.The review had 448 participants in the placebo group and 482 patients in the therapeutic group. An 8-week improvement was shown when the efficiency of PEMF was assessed for function, and no significant correlation was observed between the frequency of adverse events and PEMF use. Therefore, the purpose of this study was to assess, over the course of one month, the effectiveness of a wearable PEMF device treatment for knee OA patients in terms of pain intensity reduction using the visual analogue scale (VAS) and WOMAC. The evaluation of the algometre-measured pain threshold, the enhancements in quality of life, and the adjustments in NSAID/analgesic consumption was the secondary goal.¹¹

Method:

To make sure that all pertinent material was thoroughly reviewed, a two-phase search technique was used. Titles, abstracts, and keywords were carefully examined after the preliminary search was carried out using a variety of scholarly databases, such as Medline, PubMed, and Google Scholar¹². Keywords included “ Pulsed Electromagnetic field therapy”, “Conventional exercises”, “OA Knee”,“Pain”, and “Range of Motion” to identify studies published between 2014 to 2024The titles and abstracts that were obtained were evaluated by both researchers on their own. Full-text copies of papers that were deemed essential based on preliminary assessment or those with ambiguous abstracts were obtained in order to review them further. Finding any more randomized control trails that were discovered during the first database search was the goal of a secondary search method. We found papers from 2014 to 2024 in databases such as Scopus, Google Scholar, PubMed, Web of Science, and others. Included were studies with experimental trails. These research papers were selected using the following criteria: OA knee condition should be the emphasis of physiotherapy, rehabilitation, outcome measures, and experimental trials. The main issue in this case was severe osteoarthritis, for which pulsed electromagnetic field therapy was one of the available treatments. Conventional exercises are still another excellent choice for reducing pain and extending muscles.

Search Strategy: After our first electronic database search, we found 40 publications that were pertinent. We carried out further manual searches of reference lists, online searches, and expert discussions to make sure everything was covered. This procedure turned up one more article that might be pertinent. were finally chosen for this review's inclusion after duplicates were eliminated and a thorough screening procedure encompassing titles, abstracts, and complete texts was conducted. An overview of the article selection procedure is shown in Figure 1, which is a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart.

PRISMA FLOW CHART:

Figure 1: PRISMA flowchart

PRISMA: Preferred Reporting Items for Systemic Reviews and Meta-Analysis.

Review of Literature:

AUTHOR	DESIGN	SAMPLE	INTERVENTION AND OUTCOMES	CONCLUSION
Al-Jarrah et al	Randomised Control Trial	81	osteoarthritis (OA) of the knee and cervical spine treated with pulsed electromagnetic fields (PEMF).	At the end of treatment and at the one-month follow-up visit, patients with osteoarthritis (OA) in the treated group showed more improvement from baseline than in the placebo group.
Hasanpour-Dehkordi	A Systematic Review and Metaanalysis	25	PEMF therapy's impact on knee osteoarthritis patients' pain level, stiffness in the joints, and physical function	The results supported the use of PEMF as an adjuvant therapy method by demonstrating significant improvements in all parameters.
Zizic et al	A Randomized Controlled Trial	50	PEMF therapy for the degree of pain.	Enhanced VAS ratings, WOMAC subscales, and Analyses of acetaminophen dose within groups. Nevertheless, no statistically significant discoveries in these outcome measures that deviate from the research were found in the analyzed data between groups.
McCarthy et al.	A Systematic Review and Meta-analysis	70	PEMF therapy's long-term benefits on osteoarthritis in the knee and traditional exercises	According to research on the impact of PEMF on knee OA, PEMF is either ineffective or useless for treating knee OA. In their meta-analysis, they considered five high-quality randomized controlled studies with varying PEMF forms and treatment regimens.
Ay and Evcik et al.	A Systematic Review and experimental data &demonstration	40	PEMF in knee OA, PEMF treatment on pain level, stiffness in the joint, and knee function	PEMF has a short-term anabolic effect on osteoblasts and chondrocytes without providing any extra benefits for treating knee OA.
Ganesan et al	A controlled, randomised experimental trial	30	assessed PEMF therapy's long-term benefits on knee osteoarthritis and pain (VAS)	With little side effects, the PEMF had the potential to enhance functional outcomes and offer long-term pain relief.
Trock and Zizic et al	A Comprehensive Analysis	50	PEMF treatment for the degree of pain, PEMF therapy's long-term benefits on osteoarthritis in the knee and traditional exercises	During the brief timeframe of the current investigation, PEMF had an anabolic effect on osteoblasts and chondrocytes; However, symptom improvement was insufficient to demonstrate the proliferative effect of PEMF in knee OA.

DISCUSSION:

In managing knee osteoarthritis (OA), conventional exercise therapy—encompassing aerobic, strengthening, flexibility, and functional training exercises—plays a pivotal role by reducing pain, enhancing range of motion (ROM), and improving functional capacity. Walking, cycling, and swimming are examples of aerobic exercises that reduce knee joint stress while enhancing cardiovascular health and general fitness. To stabilize the joint and reduce discomfort, strengthening exercises focus on the quadriceps and hamstrings, which are the muscles that surround the knee. Exercises for flexibility aim to improve joint flexibility and reduce stiffness, whereas functional training improves balance, coordination, and daily task performance. There is evidence from research, including a meta-analysis by Fransen et al. (2015), that exercise therapy helps people with knee OA feel better physically and reduce discomfort.

In contrast, Pulsed Electromagnetic Field (PEMF) therapy employs low-frequency electromagnetic fields to influence cellular processes and promote tissue repair. This modality is believed to exert anti-inflammatory effects by modulating cytokine release and decreasing oxidative stress, thereby reducing joint inflammation. It may also provide pain relief by modulating pain receptors and enhancing the body’s natural pain-relieving mechanisms. Additionally, PEMF therapy could accelerate cartilage repair and bone healing by stimulating chondrocytes and osteoblasts. A systematic review by Vance et al. (2012) indicates that PEMF therapy offers moderate pain relief and functional improvements across various musculoskeletal conditions.

Recent research has explored the synergistic effects of combining PEMF therapy with conventional exercise therapy to determine if this integrated approach yields superior outcomes. Evidence suggests that combining PEMF therapy with exercise can lead to more significant reductions in knee pain than exercise alone. For example, Tontodonati et al. (2018) found that patients who received both PEMF therapy and a structured exercise program reported notably lower pain levels compared to those who underwent exercise therapy alone. Furthermore, the combined approach has been associated with improved knee ROM. A study by Matucci-Cerinic et al. (2020) highlighted that patients receiving both treatments demonstrated greater improvements in knee joint ROM than those who only participated in conventional exercise therapy. Furthermore, the combination of PEMF therapy and exercise has demonstrated encouraging outcomes in improving functional performance. Compared to individuals who received only conventional exercise therapy, Goli et al. (2022) found that participants who received PEMF therapy together with a planned exercise routine significantly improved in their capacity to do everyday activities. The potential benefits of combining PEMF therapy and conventional exercises may be attributed to their complementary mechanisms. While conventional exercises focus on muscle strength, joint stability, and functional performance, PEMF therapy may contribute by reducing inflammation, alleviating pain, and promoting tissue repair. This combination could provide a more comprehensive approach to managing knee OA symptoms, addressing both the physiological and functional aspects of the condition.

Clinically, integrating PEMF therapy with conventional exercise regimens presents a promising strategy for optimizing knee OA management. It may offer enhanced outcomes for patients, especially those who do not achieve adequate relief from exercise alone. However, it is crucial to tailor treatment plans to individual patient needs and responses. This integrated approach highlights the need for additional study to improve treatment plans and comprehend the synergistic effects of exercise and PEMF therapy on osteoarthritis of the knee.

CONCLUSION:

According to available data, PEMF therapy can help manage knee osteoarthritis more successfully than exercise alone when used in conjunction with traditional exercise. This combined therapy approach offers potential benefits in reducing pain, improving knee ROM, and enhancing functional activities. Future research should focus on optimizing PEMF therapy protocols, exploring long-term effects, and determining the most effective combinations of PEMF and exercise for diverse patient populations.

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Received on 06.04.2025 Revised on 25.04.2025

Accepted on 10.05.2025 Published on 08.08.2025

Available online from August 14, 2025

Research J. Science and Tech. 2025; 17(3):220-224.

DOI: 10.52711/2349-2988.2025.00030

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