Abstract Background: Recognizing what makes some patients to be perceived as ‘difficult’ is a clinical sign warranting a diagnostic interpretation. However, few studies have explored difficult clinician-patient encounters in physiotherapeutic practice. The present study assesses physiotherapists’ perceptions of difficult patients and their relevant management strategies in a previously unexplored context, i.e. in Nigeria. Method: Consenting physiotherapists from eight selected hospitals in Southwestern Nigeria participated in the study. A total of 110 questionnaires were administered, and 107 were fully completed and returned (97.3% response rate). A four-section questionnaire adapted from two earlier studies was employed. Descriptive statistics of frequency and percentages were used. A chi-square test was used to check associations between variables. The alpha level was set at 0.05. Results: Patients seeking multiple opinions from various professionals (55.1%), patients demanding the therapist’s knowledge and time (53.3%), and patients unwilling to participate in rehabilitation (15.0%) were mostly perceived as difficult by the physical therapists. The relationship of a physical therapist and a difficult patient mostly involves feeling rarely at ease in presence of a patient (50.5%), and feeling rarely enthusiastic about caring for a patient (48.6%). Shifting focus away from pain (32.7%) and avoiding scheduling two difficult patients consecutively (17.8%) were two most frequently agreed management strategies. There were no significant associations between the respondents’ socio-demographic characteristics and most strategies of management of the perceived difficult patient (p > 0.05). Conclusion: Patients who seek multiple opinions from various health professionals regarding their condition, and patients who demand the therapist’s knowledge and time are mostly considered to be difficult patients by Nigerian physiotherapists. Shifting focus away from pain and avoiding scheduling two difficult patients consecutively are the most rated strategies of management of such patients.