Puka Nacua’s return Sunday gave the Rams exactly the kind of spark they needed in Philadelphia, but it also came with a fresh wave of concern about the injury that had kept him out for two games.
Nacua was back in the lineup against the Eagles and looked every bit like a difference-maker, hauling in nine catches on 12 targets for 125 yards and adding a two-yard rushing touchdown in Los Angeles’ 24-20 win. For a player who missed time with what Sean McVay had described as a hip and groin issue, the performance was a reminder of just how central he is to this offense.
The catch, though, is that the problem may be more delicate than first believed. The injury has been described as a “pre-hernia,” meaning there’s a weakened or strained area in the abdominal or groin wall where tissue has not pushed through yet. It is not a true hernia, but it carries the risk of becoming one.
That’s where the concern starts to build. Pro Football Talk’s Mike Florio pointed to the demands of Nacua’s game - the hard cuts, the bursts, the sprinting - as the kind of movements that could make the issue worse and potentially lead to surgery down the line.
"It remains to be seen whether the forces applied as he accelerated, changed directions, etc. will make things worse. The overriding question is whether it can and will heal over time, especially as he continues to apply stress to the affected area," Florio wrote.
"Either way, it's a concerning situation for one of the best receivers in the NFL. And it's something that could still result in a condition that will require surgery, during or after the 2026 season."
For the Rams, this is more than just a medical storyline. They went 1-1 in the two games Nacua missed, and Davante Adams showed he can carry the load when needed. Even so, the offense clearly has a different gear when Nacua is on one side and Adams is on the other, with Kyren Williams and Blake Corum helping keep the run game alive.
If the “pre-hernia” gets aggravated badly enough to require surgery, Nacua could be looking at a recovery window of six to 12 weeks. That would put the rest of his regular season in serious jeopardy.
The timing matters, too. Nacua is coming off the best year of his career in 2025, finishing with 129 catches for 1,715 yards and 10 touchdowns.
He is also playing for his next contract, with no extension in hand and free agency scheduled for 2027. That part may not come to pass, but if this injury cuts into his season, it could ripple well beyond the Rams’ immediate playoff picture and into the future of his next deal in Los Angeles.
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