#title Luigi Mangione’s handwritten notes on his back pain & injury
#date 2019-05-18
#source Multiple linked underneath each heading.
#lang en
#pubdate 2025-06-27T04:43:48
#authors Luigi Mangione
#topics

*** 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.reddit.com/r/BrianThompsonMurder/comments/1kmovov/heres_the_full_picture_of_juless_letter/]]>

 - <[[https://www.tiktok.com/@luigiprosper/video/7503633017697586453][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

<br>

[[l-m-luigi-mangione-s-handwritten-notes-on-his-back-4.jpg]]

<br>

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

**Source:** <[[https://defenderofbasic.github.io/luigi-mangione-storyline/books/goodreads-read.html][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/1Fxjeh6cpG9kAMYNtpuCFuA_Em96sSoQV/view][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)

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

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

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

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

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