Nacua Returns with 'Pre-Hernia' Diagnosis as Rams Protect Aaron Donald

Key points

• Puka Nacua played in Week 4, catching nine passes for 125 yards against the Eagles.
• Nacua’s injury is described as a 'pre-hernia,' a weakness in the muscle wall that could develop into a hernia if not managed.
• Aaron Donald was ruled out due to back soreness, with McVay emphasizing the need to protect the veteran from himself.
• The Rams also ruled out tight end Terrance Ferguson and cornerback Jaylen Watson, while tight end Colby Parkinson was listed as questionable.
• Nacua had missed the previous two games due to groin soreness, which initially raised concerns about a hernia.

Background

Nacua had dealt with core muscle issues during training camp and subsequently missed two games with a hip/groin problem. The Rams had been managing his workload to prevent the condition from worsening. Aaron Donald had returned in Week 2 but suffered back soreness after the Week 3 game against the Denver Broncos.

How outlets are covering it

NBC Sports and the Rams’ official injury report both confirm Nacua’s return and his 'pre-hernia' diagnosis, with NBC Sports highlighting the risk of the condition developing into a full hernia. The Rams Wire emphasizes McVay’s decision to protect Donald from overexertion, noting that Donald was willing to play but the team prioritized long-term health. ESPN’s source was inaccessible, so no additional perspective could be synthesized from that outlet.

Why it matters

Nacua’s return is significant for the Rams’ offensive production, as he is one of the league’s top receivers. However, the 'pre-hernia' diagnosis raises concerns about his durability for the remainder of the 2026 season. Donald’s absence impacts the Rams’ defensive line, though McVay’s decision to protect him underscores the team’s focus on long-term player health.

What to watch

The Rams will monitor Nacua’s condition closely to prevent the 'pre-hernia' from developing into a full hernia, which would require surgery. Donald’s recovery will be assessed in the coming weeks, with the team hopeful that he can return to full strength. The Rams will also evaluate the status of other injured players, including Parkinson and Stewart, for future games.