BACKGROUND AND PURPOSE: The objective was to examine the adjuvant effect of active pulsed electromagnetic field (PEMF) versus microwave (MW) therapy, as well as sham PEMF, in addressing pain and improving functionality for treating knee osteoarthritis (KOA). METHODS: This was a double-blind, placebo-controlled, randomized clinical trial. Individuals diagnosed with KOA were assigned to an intervention combining an exercise program (EX) with active PEMF, MW, or sham PEMF. The main outcomes were pain, reported on a visual analogue scale (VAS), and functionality, assessed using the Western Ontario and McMaster Universities Arthritis (WOMAC) questionnaire, and the Timed Up and Go test (TUG). The outcomes were measured preintervention, immediately postintervention, and at 1 and 4 months of follow-up (FU). RESULTS: Sixty individuals (n = 83 knees) were evaluated. Significant between-group differences were found in WOMAC stiffness (rmMANOVA (F[2,77] 4.33, p = 0.017, partial eta2 0.10)). A notable interaction effect between group and time was found for the WOMAC pain score (rmMANOVA (F[2, 77] 3.14, p = 0.049, partial eta2 0.07)). After 4 months, the PEMF plus EX group demonstrated superior pain relief compared to the sham PEMF plus EX (WOMAC pain mean difference +/- standard error between-groups -3.2 +/- 1.2, p = 0.028) and MW plus EX (VAS pain: -2.1 +/- 0.9, p = 0.042) groups. PEMF plus EX perceived less stiffness than did the sham PEMF plus EX in both the pre-FU (WOMAC stiffness: -1.6 +/- 0.6, p = 0.047), 1-month FU (-1.7 +/- 0.6, p = 0.015) and 4-month FU (-1.4 +/- 0.6, p = 0.038), with no changes in the MW plus EX group. WOMAC function score showed greater improvement in the PEMF plus EX group compared to the MW plus EX group at 4-month of FU (-9.0 +/- 3.6, p = 0.039). Only PEMF plus EX showed a positive effect on the TUG score at 1-month FU (-1.7 +/- 0.5, p =< 0.001) and 4-month of FU (1.9 +/- 0.5, p = 0.020). CONCLUSIONS: The application of PEMF could be a useful adjuvant treatment to exercise programs to further decrease pain and improve knee stiffness and function in individuals with KOA in the medium term compared to MW and sham PEMF.

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