Objective: To determine the incidence and risk factors associated to the non-adherence to physiotherapy treatment in patients with pain and musculoskeletal disorders attending a Teaching Clinic in Lima, Peru. Material and methods: Retrospective cohort study, it included all new patients seen by pain and skeletal muscle disorders in period 2012-2014. Non adherence was measured (less than 8 sessions attended) and demographic factors. Crude and adjusted relative risks were calculates (aRR). Results: We included 549 patients: 68.3% were women, 37.2% were 60 or older, the most frequent injuries were located in the legs (34.2%) and lumbar (24.6%). We found an incidence of non-adherence of 56.4% (95% CI: 52.2 to 60.7%) and it was associated with residing far away from the clinic (aRR:1.34; 95% CI: 1.16 to 1.57) and with being less than 40 years (aRR: 1.27; 95% CI: 1.04 to 1.54). Conclusion: There is a high incidence of non-adherence to physiotherapy related to distance and age of patients, so strategies to increase adherence must be found.