The Titans moved the ball well on offense to start the game on the ground as Chris Johnson found plenty of holes to hit and was aided with a big penalty on a horse-collar tackle to move his side into the red zone. Shonn Greene took advantage of this to power in for the score from five yards.
St Louis tried to respond the score and were driving down the field using the arm of Kellen Clemens to move the chains.
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However, following a punt by the home side the Rams got themselves back in the game. Clemens engineered another impressive drive but this time they did not turn the ball over as running back Zac Stacy jinked his way into the end zone for the three-yard touchdown.
After the break, the Rams took the lead from another Stacy run, this time from nine yards out after yet another impressive drive from Clemens and his offense, which lasted over five minutes after starting on their own 20.
The Titans hit back with a methodical drive of their own as Jake Locker moved his side downfield before handing off to Johnson inside the red zone. He burst a run of pace and found a hole to drive into the end zone for a 14-yard score.
Locker handed his side the lead when he ran in for the score himself from five-yard out in the fourth quarter with the time at 9:47, but the Titans hit back within three minutes as Clemens fired a pass to tight end Jared Cook in the end zone for a 10-yard score.
The game was then to turn one way and then the other, as Locker threw an interception to gift the ball to the Rams, but the Titans were to get it back straight away as Clemens fumbled after taking a hit from Jurrell Casey and Derrick Morgan gathered.
Locker handed the ball off to Johnson, who for the second time in the game went in for a touchdown from 19 yards after finding a huge hole in the defense to win the game for his side.