You need to experiment with it. My back lets me know if it's wrong. Flipping the stem is usually a much bigger change than moving it up or down a spacer or even three, depending on the stem angle and the size of the spacers.
Stem angle and height all depends on where you handlebar needs to be for leverage, control, and comfort. With that said, I have mine set at a negative rise with spacers underneath so I can adjust as needed for different terrain/events.
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