Background: Spreadability is a critical performance attribute for semisolid formulations, influencing patient compliance, dose uniformity, and product acceptability. Despite its importance, there is no standardized method for its assessment across pharmaceutical and cosmetic applications. Objective: This review uniquely integrates systematic literature mapping with an experimental comparison of five spreadability assessment techniques, providing evidence-based recommendations for harmonizing protocols and improving reproducibility in semisolid formulation testing. Methods: A systematic search of PubMed, Scopus, and Web of Science identified 211 records, of which 14 studies met the inclusion criteria. Techniques reviewed included parallel-plate, slip-and-drag, rheometry (flow curve and amplitude sweep), texture analysis, and frictiometry. An experimental comparison was conducted on ten commercial formulations using all five techniques to assess inter-method variability and formulation-dependent behavior. Results: Texture analyzer and amplitude sweep rheometry emerged as the most reproducible and predictive methods, showing strong correlation (r = 0.74) in both literature and experimental data. Flow curve yield stress negatively correlated with parallel-plate spreadability (r = −0.796). Frictiometry results varied significantly with formulation type, particularly for ointments. Creams consistently ranked highest in spreadability across methods. Conclusion: No single method universally captures spreadability. Amplitude sweep rheometry correlated well with texture analysis, while flow curve values were more variable. Parallel-plate testing showed strong agreement with rheological and tribological methods, though texture analysis diverged, capturing distinct mechanical attributes. A tiered approach integrating parallel-plate, amplitude sweep, and frictiometry is recommended, with flow curve retained for regulatory compliance. Texture analysis provides valuable orthogonal information. Standardization of parallel-plate protocols is needed to establish unified spreadability indices.