Luigi Mangione’s handwritten notes on his back pain & injury

From Luigi to Jules — On living with chronic back pain — 2025

Sources:

• <https://www.reddit.com/r/BrianThompsonMurder/comments/1kmovov/heres_the_full_picture_of_juless_letter/>

• <https://www.tiktok.com/@luigiprosper/video/7503633017697586453>

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Re: Your 4/28 Letter:

“How do you remain so chill?”

Jules, I spent 1 ½ years living on a broken spine that I could feel sliding around every time I stood up, walked, or rolled over in bed. To exist in such a state — your physical being split in two — is an endless physical and mental war within the self.

After you have fought and won internal wars, nothing external — nothing — can ever phase you.

That, and I have the best team in the world.

Carpe Diem,

Luigi Mangione

Review of ‘Bigger Leaner Stronger’ — May 18, 2019

Source: <defenderofbasic.github.io/luigi-mangione-storyline/books/goodreads-read.html>

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Title: Bigger Leaner Stronger: The Simple Science of Building the Ultimate Male Body

Author: Michael Matthews

Read: 2019-09-??

Added: 2019-05-18

Rated: ★★★★

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The introduction to weightlifting.

Fantastic, clear content.

-1 star: too infomercial, too aesthetics-focused

My written notes: https://drive.google.com/file/d/1Fxje...

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Internal research notes – Lower back pain

My injury: L5 Spondylolisthesis

• Pars fracture → vertebra slippage/fracture

Isthmic Spondylolisthesis (spon-do-lis-the-sis)

• Repetitive stress most commonly when young (5–7 years old),

  • symptoms not developing until adulthood

• 5–7% of the population has pars fractures or spondylolisthesis

• 80% of those with spondylolysis have progression to slippage

  • is only 15–20% become symptomatic enough to require surgery

• of L5-S1 (my injury) not usual instability because ligamental (sacral alignment) prevents L5 from slipping further onto sacrum.

Grading (Severity of slippage):

• Grade 1: 0–25% of vertebra has slipped forward

• Grade 2: 26–50%

• Grade 3: 51–75%

• Grade 4: 76–100%

• My injury: ~30% slip → Low Grade 2 Common symptoms of Isthmic Spondylolisthesis:

• Low back pain

• Pain worsens with:

• Standing

• Walking

• Bending backward

• Pain improves with: Sitting Non-Surgical Treatment:

• Pain medications:

• Acetaminophen or NSAIDs to reduce inflammation

• Heat/ice therapy:

• Ice directly after activities that cause pain

• Heat before motion to promote blood flow/muscle relaxation

• Physical Therapy:

• Focus on muscle strengthening and stretching (twice daily)

• Stretching lower back

• Mostly for leg pain (sciatica)

Back Brace?

• DO NOT DEPEND ON IT

• Only for short-term relief

• Long-term use can weaken muscles, leading to:

• Increased muscle atrophy

• Increased dependence on brace

• Increased pain & chance of injury

How to adjust training?

(Source: StartingStrength.com – “Spondylolisthesis & Lifting”)

• Mark Rippetoe’s response:

• Acute models diagnose this then correct it by discouraging weightlifting

• Extension exercises worsen symptoms (e.g., sit-ups, back extensions)

• Corrective approach:

• Hold the spine in a neutral anatomical position (isometric stabilization, e.g., squats, deadlifts)

• NECESSARY for stabilizing injury

• Competing at high intensity → No longer possible, but weightlifting should not be completely eliminated

• Anecdotal evidence from others with spondylolisthesis:

• Squatting, deadlifting helped eliminate pain

• Caveat:

• Cannot lose form – might not be able to attempt max lifts

Summary of Key Points:

1. L5 Spondylolisthesis (Low Grade 2, ~30% slip)

2. Symptoms: Low back pain, worse with standing/walking, better with sitting.

3. Non-surgical treatments: NSAIDs, ice/heat, PT (stretching & strengthening).

4. Bracing: Only for short-term; long-term use weakens muscles.

5. Training: Avoid hyperextension, focus on neutral spine stability (e.g., squats, deadlifts).