Puka Nacua’s return in Week 4 gave the Rams a needed lift, but the bigger story around his absence has been the nature of the injury itself. After sitting out two games with hip and groin soreness, the wideout was back on the field against the Philadelphia Eagles, and the issue that kept him out was identified as a pre-hernia injury.
That was the same concern sports doctor Jesse Morse flagged when Nacua first dealt with the problem in Week 1 against the San Francisco 49ers. Morse said the injury could involve a weakened area or a microscopic tear in the muscle or tissue wall, usually in the abdomen or groin, before a full hernia develops.
Before Week 3, Rams coach Sean McVay said Nacua does not have a hernia, but the team is handling the situation carefully because it is not viewed as a long-term issue.
"When you're a skill player and you're really trying to hit high-speed yards and really open up and you feel just ... it's like some of the things that can almost be like pre-hernia is kind of what he's feeling," McVay said. "And so you err on the side of caution.
Usually time is the best thing that allows that thing to heal. And then once you get to a certain point, then I think you feel pretty good moving forward."
The Rams got the positive update they wanted: Nacua was able to play against Philadelphia in Week 4.
His season started with a productive outing in Australia against the 49ers. In Week 1 of the 2026 season, Nacua caught five passes for 74 yards, leading the Rams in both receptions and receiving yards, even as the team dropped a 27-7 decision.
Now in his fourth year in the league, Nacua already has two Pro Bowl selections, and the Rams are going to need him at full strength if they want to chase a Super Bowl this season.
At halftime against the Eagles, the Rams were trailing 20-10. Nacua had one catch for 28 yards and added a two-yard touchdown run on one carry.
In Other News...
Rams Enter Eagles Test With A Sudden Special Teams Problem
The Rams head into their Week 4 matchup with the Eagles carrying the usual injury baggage, but the special teams picture changed in a hurry this week. Los Angeles put tight end Terrance Ferguson on injured reserve, waived punt returner Xavier Smith and promoted running back Dean Connors to the active roster, a set of moves that puts extra attention on how the Rams handle the kicking game going into a matchup that already has plenty of personnel questions on both sides.
Philadelphia is dealing with its own absences, including DeVonta Smith and Dallas Goedert, but the Rams immediate concern is more basic: who handles returns and how cleanly the operation holds together. Those decisions tend to matter most when the games get tight, and with another short-week style test looming against a banged-up opponent, Los Angeles suddenly has one more area to sort out before kickoff. [Read more 🡒]
Rams Just Watched A Massive Eagles Threat Suddenly Leave The Game
Saquon Barkleys afternoon against the Rams changed in an instant in Week 4, when the Eagles star suffered a right hamstring injury on a non-contact run and headed to the sideline. Barkley was listed as questionable to return after leaving the field favoring his leg, and Philadelphia had to quickly reshuffle its backfield with Tank Bigsby and Will Shipley stepping in.
For the Rams, the timing mattered as much as the injury itself. Barkley is the kind of player who can force an offense to stay on schedule and stress a defense every snap, so his exit immediately altered how the Eagles had to approach the rest of the game. Any setback involving a threat of that caliber is the sort of development a defense notices right away, even before the full impact becomes clear. [Read more 🡒]
Rams Suddenly Face An Aaron Donald Concern They Didn't Expect
The Rams have spent the early part of the season juggling injuries across the roster, and the latest concern is Aaron Donald, who is now dealing with a minor back issue. With Puka Nacua working back from a hip injury and the team already planning around the absence of Myles Garrett after knee surgery, Los Angeles is trying to keep its bigger picture intact while making sure short-term absences do not snowball into something worse.
For a team that has already had to think carefully about long-term health, every additional setback complicates the weekly plan. Garretts return timeline is still unclear, though there is hope it will come sooner than a reported six-week worst-case scenario, and the Rams also made a roster move by cutting punt returner Xavier Smith because of performance issues. None of it changes the urgency of the moment, but it does underline how quickly depth and availability can shape the early months of a season. [Read more 🡒]