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AVALIAO POSTURAL GLOBAL

Nome:_______________________________________________________________________________
Nascimento:_______________Estado civil:_________________________Profisso:________________
Endereo:____________________________________________________________________________
Data da avaliao:______________Telefone:_____________________Email:______________________
1 - Objetivo Relacionado a atividade fsica:
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2 - Anamese:
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3 - Hbitos de vida e Histria pessoal:
Tabagismo:
( ) Sim ( ) No Quanto tempo:____________ Cigarros por dia: ________________
Etilismo:
( ) Sim ( ) No Tipo:____________ Quanto tempo: ______ Frequencia: _________
Sono
( ) Regular ( ) Irregular Descreva:_________________________________________
Atividade Fsica: ( ) Sim ( ) No Tipo:_________________ Freqncia: _______________________
Ingesto de lquidos:____________________________________________________________________
Alimentao:__________________________________________________________________________
Cirurgias:_____________________________________________________________________________
Gravidez: ( ) No ( ) Sim Quantas?___________ Tipo de parto:_________________ Aborto?________
4 Patologias Associadas: ______________________________________________________________
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5 Medicamentos em uso: ______________________________________________________________
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6 Exames Complementares: ___________________________________________________________
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7 - Histrico Familiar: _________________________________________________________________
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8 - Exame Fsico

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8.1 Vista Anterior
C abe a
Om bros
Tron co
ngul o de Tal es
Ci c at riz um bi li c al
C rist as Il a cas
Joel hos
P s

8.2 - Vis ta Post eri or


Escpul as
Col una Tor ci ca
Col una Lom ba r
P regas Gl t e as
Joel hos
P rega Popl t e as
Tornoz el os
8.3 - Vis ta Lat eral
C abe a
Col una C ervi cal
Om bros
Col una Tor ci ca
Rot a o t ronco
C ent ro Gravi d ade
Abdom en
Col una Lom ba r
P el ve
Quadri l
Joel ho

In cl i nad a
El evado
R odado
S im t ri co
Al i nhada
S im t ri ca
Val go
R ot ao l at er al
P l ano
P ronado

R odada
Dep ri m i do
In cl i nado
Mai or
Desvi o
El evad a
Var o
R ot ao m edi al
C avo
S upi nado

Abduz i da
El evada
Escol i ose

Aduz i da
P rot usa
Ci fose

Si m t ri cas
Rot a o l at e ral
Si m t ri cas
Val go

El evad a
R ot ao m edi al
El evad a
Var o

Ant eri ori z ada


Hi perl ordose
Ci fose
P rot usos
Rodados
Hi perci fose
Di rei t a
fr ent e
P rot uso
Hi perl ordose
Ant evers o
Fl et i do
Fl et i co

P ost eri orz ada


R et i fi cad a
R et ra dos
P l ano
Esque rda
P t ose
R et i fi cad a
R et rove rso
Norm al
Hi pe rex t endi do

8.4 - Fl exi bl i d ad e :
Tr c eps S ural :
Isq ui oti bi ai s:
TF L:
Quadr c eps:
Rot ador es ext e rnos:
Rot ador es i nt ernos:
Adut ores de quadri l :
P arave rt ebr ai s:
Quadr ado l om bar:
Fl ex ores de om bro:
Ex t ensores de om bro:
Adut ores de om bro:
Abdut ores de om bro:
Fl ex ores de pescoo:
Ex t ensores de pesco o:
Rot ador es de pescoo:
9 - Testes esp eci ai s:
9.1 - E xame d o Core
Enrol am ent o da col una
Pont e
Pont e esquerd a
Pont e di r ei t a
P rancha
P rancha esque rda
P rancha di rei t a

Bom
Bom
Bom
Bom
Bom
Bom
Bom

R e gul ar
R e gul ar
R e gul ar
R e gul ar
R e gul ar
R e gul ar
R e gul ar

9.2 - Fora
Meio agachamento

3_______________________________

Agachamento completo

3_______________________________

Elevao de calcanhar

3_______________________________

Push up

3_______________________________

Prancha lateral

3_______________________________

Super-homem

3_______________________________

Flexo ombro em prono

3_______________________________

Rolamento pra cima

3_______________________________

Hundred

3_______________________________

9.3 - Flexibilidade
Aranha na parede

3_______________________________

Extenso em prono

3_______________________________

Rui m
Rui m
Rui m
Rui m
Rui m
Rui m
Rui m

Sentado (pernas estendidas)

3_______________________________

Sentado (pernas afastadas)

3_______________________________

Sentado em Z

3_______________________________

Flexo joelho prono

3_______________________________

PONTUAO TOTAL: _______ / _______ = ________


NVEL DE FITNESS:
INICIANTE
(0,0 a 1,4)

INTERMEDIRIO
(1,5 a 2,4)

AVANADO
(2,5 a 3,0)

Principais dificuldades: ________________________________________________________________


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10 - Concluso Final:
Atividade a ser praticada/freqncia: _______________________________________________________
R est ri o s dem ai s at i vi dades: _____________________________________________________
Indicao: ____________________________________________________________________________
Orientaes: __________________________________________________________________________
Fort al ece r

Al ongar

Evit a r

C ui dado/ At en
o

Evit a r

Observ ao:

C i ent e, ____________________________________________________
Belo Horizonte, ________de_______________ de 20_____.
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Fi si ot erap eut a