The Los Angeles Rams’ injury woes continue, as wide receiver Puka Nacua is very likely heading to the injured reserve with an MCL and PCL sprain in his right leg, as well as turf toe.

And head coach Sean McVay admitted he’s "kicking himself" after Nacua’s knee ailments occurred on the final play of Sunday’s game where the Rams were leading the Washington Commanders.

"I'd be lying to you if I said I haven't questioned the decision-making on that last play over and over in my head of what could have been another option that you felt like could have gotten a conversion, and maybe ended the game that would've led to him not taking a violent hit to his right knee," McVay explained to reporters on Monday, per ESPN.

"And so, it's stuff that I feel tremendous responsibility for, and we've got to be able to figure out how to protect these guys while also putting them in positions that help our team and allow them to be able to shine."

Nacua was given a hand-off on a third-down play where the Rams were trying to end the game. He rushed for five yards, but he took a massive hit and stayed down on the ground longer than expected before walking off on his full power.

But McVay revealed that Nacua will be missing a good chunk of time, and this is a team that’s already ailing at receiver with Davante Adams out for quite a while with a hamstring tear in Week 6 against the Arizona Cardinals.

If Nacua officially hits the IR as McVay indicated, he would be forced to miss the next four games for Los Angeles, which include matchups with the Cardinals, Green Bay Packers, Kansas City Chiefs and San Francisco 49ers.

With their top two receivers on the shelf, McVay said the Rams would "look at all avenues," including a potential trade before the Nov. 10, 4 p.m. ET NFL deadline, to add a receiver that quarterback Matthew Stafford could utilize.

Nacua is an obvious loss for this offense, as Stafford feels very comfortable giving him the ball no matter where he is on the field. Even missing Weeks 2 and 3 with a hip injury, Nacua has 70 catches for 715 yards and four touchdowns.

Those 70 receptions are the most for a player through their first seven games in NFL history.

This isn’t at all how the Rams, and the football world for that matter, saw their 2026 season unfolding with a 5-4 record after Week 9. But injuries to players like Myles Garrett, Aaron Donald, Jaylen Watson and many others have led McVay and his coaching staff to be creative in filling the gaps.

If the season were to end today, the Rams would not be in a playoff spot, and they are among teams with the hardest schedule moving forward. So, that creativity by McVay and others will be forced for weeks to come.

But this is an injury McVay can’t let himself off the hook for.