Motivation research is central to understanding why certain students exhibit high levels of behavioral, cognitive, and emotional engagement with learning, and why others lack interest, display boredom, and withdraw effort (i.e., are disaffected). In this review, tenets within self-determination theory (SDT) are used to provide a theoretically-informed account of student engagement and disaffection in the context of school physical education (PE). Our review centers on the proposition within SDT that the satisfaction of basic psychological needs (i.e., for autonomy, competence, and relatedness) provide the energizing basis for optimal motivational functioning and wellness. Teacher strategies and class structures are reviewed in the context of whether they satisfy or frustrate these psychological needs. To amalgamate the reviewed literature, a mediated model depicting a ‘student-teacher dialectical’ framework is presented. Several practitioner recommendations for supporting student engagement in PE are then offered. Lastly, findings of past interventions within the school context are presented and discussed.