Background Musculoskeletal disorders (MSDs) are the leading cause of disability worldwide and the primary reason for healthcare utilization. Understanding a patient's rehabilitation goals and their motivation for pursuing those goals are a core component of contemporary chiropractic and physical rehabilitation care. The purpose of this study was to describe the patient-generated motivation statements for pursuing their rehabilitation goals prior to initiating treatment at chiropractic and physical rehabilitation clinics.Methods A cross-sectional thematic analysis was conducted on 5,326 de-identified motivation statements entered by adult patients using a digital health platform across 24 U.S. chiropractic and physical rehabilitation clinics (2023-2025). An LLM-assisted coding process classified the motivation statements into10 thematic categories, a subsample of which were validated by independent human reviewers (92% agreement). Additional analyses evaluated the presence of SMART elements in Pg 2the motivation statements and classified the statements as growth-focused, problem-focused, dual, or neutral in orientation.Results Pain reduction was the most frequent theme for the motivation statements (27.5%), followed by physical function enhancement (17.8%), body structure concerns (13.6%), sports/recreation (9.5%), and return to baseline (8.1%). Motivation statements were typically brief (median 7 words). Approximately half (49.5%) included the SMART elements of measurability, 23.4% referenced specific activities, and 5.3% were time-bound; none included achievable or relevant components. Growth-focused motivation statements comprised 29.3% of responses, compared with 14.7% problem-focused and 9.1% dual-orientation goals; 46.9% were neutral.Conclusions Patients prioritize both symptom relief and functional improvement, though most motivation statements lack SMART elements. Digital platforms may facilitate patient-centered motivation statements while providing opportunities for clinicians to collaboratively refine motivation statements toward growth-oriented, function-based outcomes that support sustained rehabilitation engagement.- Trial registration Not applicable.