Background <p>The worldwide prevalence of lumbar disc herniation (LDH), a chronic low back pain condition, continues to increase because it represents a major global musculoskeletal health issue. The frequent recurrence of LDH requires patients to maintain their rehabilitation exercises, but there are significant differences in the degree of adherence of patients to their training plans. Protection motivation theory (PMT) provides researchers with a method to study the mental processes that influence health-related actions. Previous studies have not fully explored how different levels of patient motivation affect their adherence to exercise.</p> Methods <p>Data were collected from June to October 2025 from 372 LDH patients in Zhejiang Province who received care at a tertiary hospital. The researchers used six PMT subscale scores as indicator variables to perform latent profile analysis and selected the best number of profiles on the basis of model fit indices. The researchers used ANOVA and Kruskal‒Wallis and chi‒square tests to evaluate how demographic and clinical variables and exercise adherence differed between profiles. The researchers used multiple linear regression to determine whether motivational profiles independently predicted exercise adherence.</p> Results <p>This study revealed three distinct exercise protection motivation profiles among patients with lumbar disc herniation: the first was “High Protection Motivation–Autonomous Management” (26.1%), the second was “Medium Protection Motivation - Cognitive - Behavioral Disconnection” (43.8%), and the third was “Low Protection Motivation–Negative Avoidance” (30.1%). Individual profile affiliation was significantly associated with age, pain intensity, economic status, and comorbidities. The level of adherence to exercise differed significantly across the profiles (<i>p</i> &lt; 0.001), with the highest degree of adherence observed in the high-motivation group. After adjusting for covariates, regression analysis confirmed that latent profiles of protective motivation remained significant independent predictors of exercise adherence.</p> Conclusions <p>Patients with LDH exhibit three distinct motivational profiles that are closely associated with exercise adherence. This study extends the application of protective motivation theory to the field of musculoskeletal rehabilitation while providing valuable insights for identifying key intervention populations, defining specific intervention targets, and developing intervention strategies.</p> Clinical trial number <p>Not applicable.</p>