In December 2024, Josh Allen put together a stat line the NFL had never seen before: three passing touchdowns and three rushing scores against the Los Angeles Rams. Buffalo still lost 44–42. It was the kind of performance that showed how much Allen could do with the ball in his hands, without guaranteeing the Bills a win.

Monday’s rematch brought another test of that ability. Allen ran for 121 yards, then ripped off gains of 19 and 13 yards in overtime to help set up Buffalo’s winning field goal. After seven previous overtime games without a win, he finally got one, as the Bills escaped with a 37–34 victory. But the win also brought a concern that Allen’s rushing heroics could not answer.

“Bills QB Josh Allen told reporters that he’s working through a mechanical issue with his throwing,” Lance Lysowski of The Buffalo News reported on X. “Decided to stop thinking about it in the second half and let it rip. Wished he had taken more underneath throws early in the game.”

Head coach Joe Brady admitted the Bills had not passed the ball well against Los Angeles.

He completed just four of seven passes for 60 yards in the first half before throwing an interception to Rams cornerback Jaylen Watson. He later found a rhythm, completing all five of his passes for 112 yards in the fourth quarter. Allen finished with 12 completions on 19 attempts for 210 yards, one touchdown and one interception.

Joe Brady did not gloss over those struggles. “We weren’t good passing the ball tonight,” the Bills head coach said, adding that he needed to do a better job of getting Allen into a rhythm early. Brady pointed to missed opportunities on easy completions that could have helped Allen settle into the game.

“I hope his legs aren’t the answers always and that’s why we have to do a better job in the pass game,” Brady said.

That concern was understandable given how much Buffalo relied on Allen’s running. He carried the ball 10 times for 121 yards and a touchdown, his second-highest single-game rushing total. His career high remains the 135 yards he recorded against Miami during his rookie season in 2018. Against the Rams, his two overtime runs, a 19-yard gain on second-and-7 followed by a 13-yard carry, moved Buffalo into position for Tyler Bass’ winning field goal.

Allen was not the only reason the Bills found success on the ground. Buffalo rushed for a season-high 234 yards, with James Cook contributing 111 yards and two touchdowns. But Allen’s contribution was particularly striking: he recorded his eighth rushing touchdown of the season and became the first quarterback in NFL history to score on the ground in each of his team’s first five games of a season.

The quarterback also acknowledged that Los Angeles had made life difficult for the passing game. “That’s just kind of how the game rolled,” Allen said. “[Los Angeles] is a really good secondary and a really good defense.”

His comments about the Rams’ coverage offer some context for the missed underneath throws he mentioned, although they do not explain the mechanical issue itself.

The injury speculation emerged after reporter Matt Parrino shared a practice clip in which Allen appeared to bump his right hand during a drill. The Bills injury commentator known as Thigh Doctor subsequently suggested the issue might involve Allen’s thumb. Neither observation confirms that Allen has suffered a hand injury, let alone establishes that a physical problem caused his passing struggles against the Rams.

Allen does have a history of playing through injuries. In September 2024, he fractured his left, non-throwing hand during a touchdown run against the Arizona Cardinals. He stayed in the game and subsequently played through most of his MVP-winning season without missing a game or practice because of the injury. NFL Network later reported the fracture’s severity, which had not been publicly established when Allen first hurt his hand.

There was another significant example late in 2025. Allen later revealed that he had played through a broken bone in his right foot, an injury he sustained against the Cleveland Browns in December. He underwent a procedure to repair the fifth-metatarsal fracture in January 2026.

“Painful throughout the weeks,” Allen said of the foot injury, explaining that he put it aside on game day to play football.

Those injuries provide context for why another physical concern involving Allen would draw attention, but they should not be conflated with his current throwing issue. His previously confirmed injuries involved his left hand and right foot; the mechanical problem he described against the Rams has not been tied to either one.

The passing numbers do give Buffalo a separate issue to address. Allen threw four interceptions across his last three games, after opening the season’s first two games without one. Over that same three-game stretch, he recorded two passing touchdowns and four rushing touchdowns. The split shows how heavily Buffalo has leaned on his legs while the passing game has been less productive, but it does not establish that the mechanical issue caused the turnovers.

Allen was candid about the need to improve after the win. “Don’t think we threw it very well, especially in the first half but our team kept fighting. We found a way to win, it’s the first OT [win] I’ve got, so it feels good being on this side,” he said.

The Bills moved to 4–1 and took the lead in the AFC East, but Brady’s comments made clear that the offense cannot depend on Allen’s rushing production to solve every passing problem.

Buffalo now turns to its Week 6 matchup against the Las Vegas Raiders. The priority will be getting Allen comfortable in the passing game and helping him take the shorter completions he felt he passed up against Los Angeles. Until the team provides further information, the mechanical issue is the confirmed concern; the possibility of an underlying hand injury remains unverified.