Magnetotherapy in Clinical Practice: Mechanisms, Clinical Evidence, and Therapeutic Implications – A Comprehensive Review

Abstract

Magnetotherapy is an umbrella term applied to interventions that differ substantially in physical exposure, biological plausibility, and intended clinical effect. Static permanent magnets generate time-invariant fields, pulsed electromagnetic field (PEMF) devices generate time-varying low-frequency fields that induce electric fields in tissue, and repetitive peripheral magnetic stimulation (rPMS) uses higher-rate field changes to depolarise peripheral nerves and recruit muscle and proprioceptive afferents. Treating these modalities as interchangeable has contributed to inconsistent interpretation of the clinical literature. This critical narrative review evaluates their biophysical and biological mechanisms, clinical effectiveness, safety, dosimetry, and therapeutic implications. Literature published principally from 2000 to 2 August 2026 was identified through open scholarly sources, with earlier seminal work retained when necessary to interpret the field. Evidence was appraised with attention to sham credibility, sample size, outcome selection, follow-up, stimulation parameters, risk of bias, and mechanistic-clinical concordance. Static magnets have not shown reproducible analgesic efficacy across controlled trials and meta-analysis. Low-intensity PEMF has a more coherent mechanistic literature involving induced electric fields, adenosine receptor signalling, inflammatory pathways, and extracellular-matrix regulation, but cellular effects are strongly exposure-dependent and cannot be assumed to predict clinical benefit. The most consistent clinical signals for PEMF concern short-term symptoms in knee osteoarthritis and chronic low-back pain, while evidence for acute fracture healing, pressure-ulcer healing, and broad whole-body applications is insufficient or negative. Bone-healing evidence is indication-dependent: pooled trials suggest possible benefit across heterogeneous fracture populations, yet high-quality acute-fracture trials and recent reviews do not support routine prophylactic use. rPMS represents a distinct neuromodulatory intervention with plausible sensorimotor mechanisms and emerging signals in fibromyalgia, chronic musculoskeletal pain, and post-stroke rehabilitation, but certainty remains low. Across modalities, dose heterogeneity, incomplete field reporting, small samples, short follow-up, and imperfect blinding limit translation. Magnetotherapy should therefore be interpreted as a family of device-specific interventions rather than a single therapy, with clinical use matched to modality, indication, and evidence quality.