Ficha fisioterapia desportiva

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DADOS PESSOAIS DATA: __/___/___
	NOME: 
	ENDEREÇO: 
	TELEFONE: 
	IDADE: SEXO:
	EMAIL: 
	ESPORTE PRATICADO:
	TIPO DE ATLETA: ( ) PROFISSIONAL ( ) AMADOR ( ) RECREACIONAL
ANAMNESE
Q.P: ______________________________________________________________________________________________________________________________________
H.M.A: ______________________________________________________________________________________________________________________________________
H.P: ______________________________________________________________________________________________________________________________________
Cirurgias:
______________________________________________________________________________________________________________________________________
Medicamentos em uso: ______________________________________________________________________________________________________________________________________
 Exames Complementares: ______________________________________________________________________________________________________________________________________
EXAME FÍSICO: 
PA: _____X_____ mmHg FC: _______ bpm Peso: _________ Altura: _________ 
IMC: _______ (Baixo Peso: < 18,5; Normal: 18,5-24,9; Pré-Obeso: 25-29,9; Obeso I: 30-34,9 Obeso II: 35-39,9).
Dor em alguma Parte do corpo? SIM______ NÃO _____
 
COMPORTAMENTO E CARACTERÍSTICAS: ______________________________________________________________________________________________________________________________________
FATORES QUE PIORAM E ALIVIAM: ______________________________________________________________________________________________________________________________________
RESPOSTA AO ESPORTE:
___________________________________________________________________
Escala Analógica da dor: 0 ____________________ 5 _____________________ 10
Obs:
GONIOMETRIA: 
FORÇA MUSCULAR:
AVALIAÇÃO POSTURAL:
Vista anterior
 Seguimento D E Característica Observação
Cabeça ( ) Linha Média Cabeça 
 ( ) Rodada p/ D ( ) Rodada p/ E
 ( ) Fletida p/ D ( ) Fletida p/ E
Ombros ( ) ( ) Alinhado 
 ( ) ( ) Elevado 
 ( ) ( ) Deprimido 
Clavículas ( ) ( ) Alinhada
 ( ) ( ) Verticalizada (>20°)
 ( ) ( ) Horizontalizada (<20°)
Tórax ( ) Normal
 ( ) Peito de Pombo
 ( ) Em tonel
Braços ( ) ( ) Neutro
 ( ) ( ) Pronado
 ( ) ( ) Supinado
Triângulo de Tales ( ) Simétrico
 ( ) Diminuído à D
 ( ) Diminuído à E
Pelve ( ) Alinhada ( ) Rodada anterior
EIAS ( ) Elevadas
 ( ) Elevada à D
 ( ) Elevada à E
Massa do Quadríceps ( ) Simétrico
 ( ) Assimétrico
Patelas ( ) ( ) Simétrica
 ( ) ( ) Elevada
 ( ) ( ) Lateralizada
Joelhos ( ) ( ) Normal
 ( ) ( ) Valgo
 ( ) ( ) Varo
Hálux ( ) ( ) Normal
 ( ) ( ) Valgo
 ( ) ( ) Varo
Pés ( ) ( ) Normal ( ) ( ) Arco normal
 ( ) ( )Pronado ( ) ( ) Aro cavo
 ( ) ( )Supindo ( ) ( ) Arco plano
 ( ) ( ) Antepé valgo
 ( ) ( ) Antepé varo
Vista lateral
 Seguimento D E Característica Observação
Cabeça ( ) ( ) Alinhada
 ( ) ( ) Protusa
 ( ) ( ) Retraída
Cervical ( ) ( ) Normal
 ( ) ( ) Hiperiordose
 ( ) ( ) Retificada
Ombros ( ) ( ) Normal
 ( ) ( ) Protuso
 ( ) ( ) Retruso
Torácica ( ) ( ) Normal
 ( ) ( ) Hipercifose
 ( ) ( ) Retificada
Lombar ( ) ( ) Normal
 ( ) ( ) Hiperlordose
 ( ) ( ) Retificada
Pelve ( ) ( ) Neutra (30°)
 ( ) ( ) Anterversão
 ( ) ( ) Retroversão
Joelhos ( ) ( ) Normal
 ( ) ( ) Hiperextensão
 ( ) ( ) Genoflexo
Vista posterior
 Seguimento D E Característica Observação
Escápulas ( ) ( ) Normal
 ( ) ( ) Aduzida
 ( ) ( ) Abduzida
 ( ) ( ) Alada
 ( ) ( ) Elevada
 ( ) ( ) Deprimida
Processos espinhosos ( ) Alinhados
 ( ) ( ) Desvio
EIPS ( ) ( ) Alinhadas
 ( ) ( ) Elevada à D
 ( ) ( ) Elevada à E 
Pregadas glúteas ( ) Simétrico
 ( ) ( ) Assimétrico
Massa do tríceps ( ) ( ) Simétrico
 ( ) ( ) Hipotrófica
 ( ) ( ) Hipertrófica
Tendão do calcâneo ( ) ( ) Normal
 ( ) ( ) Valgo
 ( ) ( ) Varo
Diagnóstico Fisioterapêutico: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Objetivos do Tratamento: 
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Conduta:
_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Reavaliação / Término da Atividade: 
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________