Mri shows minimal diffuse disc bulge at l5-s1 and mild anterior left s1 nerve root flattening. pain is intermittent and ranges from severe days to nothing. if this is minimal is the reason it caused that much pain because its flattening a nerve?

The pain is directly related to flattening the nerve. Minimal is all relative. It is really painful for you when it occurs but does go away intermittently. In the vast range of symptoms and disability that comes from the back with disc degeneration and nerve toot problems, that is minimal. Over time the disc will dry up and bulge less and hopefully cause less irritation of the nerve.

The key issue is whether the nerve compression is causing muscle weakness and atrophy in an S-1 distribution, and if this is progressive. Yes, you can otherwise have your pain treated, engage in physical therapy and exercise, and hope that this disc desiccates and shrinks, but that will take about 9-10 months. See a physiatrist and consider an epidural steroid injection.

If the pathology is not too severe orthotics with lift therapy can be very effective. a limb length or a pelvic rotate too can cause these symptoms .