Successful Physical Therapist Management of an Ankle Injury in the Austere Wilderness of Denali: A Case Report

Abstract

BACKGROUND: Evaluation and management of ankle injuries is routine in traditional clinical settings. However, minimal evidence exists regarding the management of acute musculoskeletal injuries in austere high-altitude wilderness environments. CASE PRESENTATION: The patient was a 36-year-old male who sustained a right lateral ankle sprain climbing down from an elevation of 16 000 ft on Denali, the tallest mountain in North America. The baseline Lower Extremity Functional Scale (LEFS) score was 9/80 and the baseline numeric pain-rating scale (NPRS) score was 9/10. Management included manual therapy, therapeutic exercise, and sport-specific mountaineering interventions. After 3 days, his LEFS score improved to 55/80 and NPRS improved to 4/10. Before subsequent descending of 7000 ft to the base camp, ongoing management including boot fitting and gait training with crampons was provided to safely descend challenging terrain. OUTCOME AND FOLLOW-UP: The patient was able to descend to the base camp under his own control, saving substantial people power after significantly improving his functional level with physical therapist management. During a virtual follow-up visit 2 weeks after the expedition, his LEFS score was 72/80 and his NPRS score was 2/10. All improvements were maintained at 3-month follow-up. DISCUSSION: A physical therapist in an austere wilderness setting was able to effectively manage an ankle injury in a challenging environment with limited resources. Due to the patient's successful outcome, he was able to avoid the cost of a helicopter rescue and save precious national park resources. JOSPT Cases 2023;3(1):74–80. Epub: 14 December 2022. doi:10.2519/josptcases.2022.11159