The film begins with real-life footage of Burma soldiers committing genocide and other atrocities, and shows how they force young boys into becoming soldiers. Next, we see Lt. Aye (Aung Aay Noi) and a bunch of Burmese soldiers forcing civilians out of a truck. One soldier walks out to a field and throws an explosive into a swamp. He then throws a bunch of other explosives into the water while the civilians have their backs turned and their money taken. The soldiers order the civilians to go across the swamp. As they do, one person is blown up by one of the explosives. The others refuse to go on, and so they are shot to death by the soldiers. During the opening credits, we see John Rambo (Sylvester Stallone) catching snakes in a jungle in Thailand. He also uses a bow-and-arrow to shoot a fish and then gives it to some fisherman passing by in their boat. Rambo and his helpers go to a snake village, where the owner pays Rambo for the snakes he captured. His only complaint though is for Rambo to get more pythons, since he keeps on bringing back cobras. While Rambo puts the snakes away, Michael Burnett (Paul Schulze) approaches him and introduces himself. Michael is a missionary, and he was told that Rambo is the boatman who knows the river best. Rambo says that it’s true, and Michael wants to hire him to bring him and his group to Burma. Rambo says that it’s a war zone, but Michael says that this is his fifth time going in and they are all aware of the dangers involved. Rambo asks him if they’re bringing any weapons with them. Michael says no, and Rambo tells him that they’re not going to change anything. Sarah (Julie Benz), one of the missionaries, tells Michael that she’ll try to persuade him. Sarah tries her best to convince Rambo to transport them to Burma, but he still refuses. He tells her to go home instead.
Back in Burma, Aye’s soldiers raid a village and take all the children hostage. The women cry and beg for their loved ones. Aye tells them that the boys will now be soldiers. If the women try to get help from the rebels, they’ll come back and cut out their tongues. Rambo makes himself a blade and goes to his boat when he sees Sarah waiting for him. She again pleads with him to transport them to Burma, and he still refuses. She says that trying to save a life won’t waste his, and he must still believe in something. After Sarah leaves, Rambo thinks about it and then changes his mind. The next day, Rambo and the missionaries travel down the river in his boat. Sarah thanks Rambo again for helping them, and then asks him what his name is. He says John, and she asks him where he’s from. Rambo says that he’s from Arizona, and he hasn’t been back since he was drafted in the Vietnam War. Sarah asks him if he’s at least a little curious as to how his home has changed, but he doesn’t have a reason to be curious. He also mentions that his father might still be alive back home. Before Sarah returns to her seat, Rambo says that they shouldn’t go on, and that they can turn back whenever she wants.
At night, while the missionaries sleep, Rambo makes the boat quiet down. Michael asks him what’s wrong, and Rambo sees pirates nearby. He tells everyone to get down and be quiet while they travel unnoticed. They’re almost in the clear, but the pirates spot them and fire at them. Rambo stops the boat and tells everyone to keep their heads down. If they look the pirates in the eyes, they’ll be killed. A pirate boat pulls up to them and several men hold everyone at gunpoint. They say that they’re trespassing in their territory, and they have to pay. Rambo says that he’ll pay him whatever they want from the boat, but then the pirates see that Sarah is female. They order for Sarah to come with them, and Rambo offers them anything else but her. Tension escalates, and Rambo pops out a pistol and pumps all the pirates full of bullets. One pirate is still alive, and so Rambo unloads his last bullets into his head. Michael voices his disapproval over what just happened, and so Rambo grabs him and tells him that if he didn’t kill them, they would all be dead and Sarah would’ve been raped. Rambo says that they’re going to turn back, but Sarah wants them to continue on since they’re so close. Rambo eventually agrees to go on, and they arrive in Burma the next day. While the missionaries get out, Michael says that he has to report Rambo for killing the pirates. He also says that they’re going to take another way out instead of his boat, and so he doesn’t have to wait for them. Sarah gives Rambo a crucifix necklace as a way of saying thank you for what he did. All the missionaries take off and hike to a village. As they do, Rambo travels back and comes across the pirate boat again. He douses it with gasoline and then lights it on fire, causing it to explode.
The missionaries get to the village, where they are greeted by the locals. One missionary is a dentist, and he inspects everyone’s mouths. One missionary hands out bibles and starts to preach about god while another missionary records him with his video camera. Sarah walks to where Michael is, where he’s treating people’s wounds. Sarah looks at the people waiting to be looked at by Michael, who are missing legs and arms. Suddenly, explosions begin to rip through the village. Aye and his soldiers have arrived, and they proceed to slaughter everyone in sight. One missionary gets his legs blown off by an explosion. The unarmed civilians are shot to death by the soldiers. Some soldiers set the people on fire with flamethrowers. Children are brutally shot to death, and a soldier throws a woman’s child into a burning hut. During the massacre, the remaining missionaries try to run away, but they are beaten and captured by the soldiers. Aye watches as the village burns and the ground is littered with corpses. Some time passes, and Rambo dreams about what has happened to him in the past. He is woken up by Arthur Marsh (Ken Howard), who calls out his name. Arthur apologizes for coming to him like this, but he wouldn’t come if it wasn’t important. Arthur is a reverend at a church in Colorado, which is where the missionaries are from. Before they left, Michael told him that Rambo was going to transport them to Burma. It’s been a week since they were supposed to be back, but they never showed up. Arthur has been in contact with some rebels, and they have a good idea of where they were taken. Rambo believes that they’re probably dead, and recommends that Arthur talks to an embassy. He already has, and they won’t help him in time. He has hired a bunch of mercenaries, and he wants Rambo to take them to the exact spot where he dropped off the missionaries for a rescue mission. Rambo agrees to do it, and makes another blade for himself.
The next day, Rambo transports the mercenaries down the river. Diaz (Reynaldo Gallegos), Reese (Jake La Botz), En-Joo (Tim Kang), and School Boy (Matthew Marsden) are lead by Lewis (Graham McTavish), who constantly complains on how slow they are moving. Reese passes the time by singing, which annoys everyone else. The others pass the time with jokes and the like. Lewis tells Rambo that his boat is a piece of shit, and he could swim there faster than they are going. Rambo stares him down, but Lewis says that he does not impress him. School Boy introduces himself to Rambo, saying that he got his name in sniper school and he hasn’t been able to get rid of it (regardless of how many people he’s shot). They eventually get to the spot where Rambo dropped off the missionaries. Lewis is pissed, since they were supposed to get some reinforcements from the rebels, and they only sent two people (one’s their guide, the other is a boy). Also, Reese gets nervous when their guide tells them that they face more than 100 Burmese soldiers. Lewis asks the mercenaries if any of them are carrying explosives. School Boy is the only one, and he’s carrying a claymore mine. Rambo docks and grabs some blades, but Lewis tells him to stay with the boat. Rambo says that his men stay with the boat, but Lewis still orders him to stay with the boat, even though School Boy doesn’t have a problem with him tagging along. The guide takes the mercenaries through the jungle and they come across an old bomb that was dropped from WWII, which didn’t explode when it hit the ground. After a long hike, they come to the remains of the village. Flies are swarming around the dead bodies, a severed head has been impaled on a stake, and some corpses have been hanged as a warning to the rebels. Everyone is disgusted by the slaughter, and the guide warns them to watch where they step, since there are still mines around, and then sends the boy home.
As they walk through the destroyed village, some Burmese soldiers drive out to where they are. The mercenaries hide as the soldiers force civilians out of the truck and take their money. A soldier throws some explosives into the swamp between them and the mercenaries. The soldiers force the civilians to run across to the other side. Scared, all the civilians dash across to the other side without being killed by the explosives. The soldiers order them to run back across to where the truck is, but they are too scared to move. The soldiers try to scare them into running again by firing at them. School Boy wants to fire at them, but Lewis says that if they shoot, it’ll attract the other soldiers at the nearby base (which is where the missionaries are). Rambo suddenly appears out of the jungle and shoots all the soldiers using his bow-and-arrow. He hits with deadly precision, and he shoots one soldier through the chin. The last soldier is shot in the leg and in the head, which causes his body to fall in the water and blow up from one of the explosives. The mercenaries are astounded at how Rambo killed the soldiers. The guide says that he can take them to the base, but Lewis and the others are ready to split. Rambo aims an arrow at Lewis’ eye and is held at gunpoint by Reese and En-Joo. Rambo tells Lewis that none of them want to be there, and they can live for nothing or die for something. School Boy is with Rambo, and soon the others agree to continue on. Back at the base, soldiers throw food at women locked in cages, and Aye inspects the captured missionaries. One of them looks him in the eye, which causes Aye to order one of his men to feed him to the pigs.
Later that night, the mercenaries drive to the camp using the truck from the soldiers Rambo killed. The guide is dressed as a soldier and drives them to the gate. It’s raining, and once the guard recognizes the truck he lets them enter. School Boy sneaks up on a guard by the gate and knifes him. He then sets up his sniper rifle and waits. Rambo and the mercenaries plan to move out at 1:15 AM, which is in 20-30 minutes. One by one, they each jump out of the truck and sneak around the base. Most of the soldiers are busy in a hut, watching captured women dance and throwing things at them. Rambo finds Michael and another missionary in a cage, with a dead missionary nearby (still being eaten by the pigs). He frees them and tells them to stay put until he comes back. Sarah remains held captive, tied up underneath a hut. The soldier who lives in the hut drinks some alcohol and walks off. At Aye’s hut, a soldier brings him a young boy and Aye strokes his hair. He then shuts the door, implying that he has sex with the boy. The soldiers in the main hut get more rowdy and start throwing the dancers off the stage. One soldier takes a woman for himself and runs off to his hut. He roughs her up a bit and she crawls underneath the hut. En-Joo happens to be there, and when the soldier looks underneath he is stabbed to death by En-Joo. Rambo meets up with Reese, and tells him to retrieve Michael and the missionary he freed. Diaz frees some of the caged women and they make their way towards the gate. Rambo eventually finds where Sarah is, but the drunken soldier comes back and takes her upstairs. He throws her on the floor and is about to rape her when Rambo sneaks up behind him and rips his throat out with his bare hands. School Boy kills the guards at the gate with his sniper rifle, which allows the others to escape. It’s 1:15 AM, but Rambo and Sarah aren’t back yet. Lewis and the others are ready to leave, but School Boy says that they should wait for them. Michael also doesn’t want to leave without Sarah, but Lewis throws him down and threatens him with his knife. They all decide to run off and leave Rambo behind.
Rambo and Sarah get to the gate, but are held at gunpoint by two soldiers. Rambo jumps on Sarah to shield her from being shot. One soldier is blasted in the chest and goes flying back. The other soldier has his head blown off and his body flies back like a rag doll. Turns out that School Boy stayed behind to wait for them. It’ll be light in an hour, and so they take off running into the jungle. When light comes, the soldiers find the dead soldiers and sound the alarm. Aye comes across the corpse of the soldier who had his throat ripped out and gets pissed. They all mount up and take off into the jungle with dogs. While the mercenaries and the remaining missionaries run in the jungle, Lewis steps on a mine and his leg is shredded. Also, their guide has run off and ditched them. Michael tells the others to make a stretcher from the bamboo around them, and they proceed to carry Lewis. Elsewhere, School Boy hears the dogs the soldiers have and realizes that they are tracking them. Rambo takes his claymore mine and ties a piece of Sarah’s shirt around his boot. He then has School Boy fire off a shot and orders them to get to the boat without him. The mercenaries hear the shot and pick up the pace while the soldiers also move faster. Rambo runs by himself through the jungle while the soldiers with the dogs chase after him. Rambo gets to the old WWII bomb and sets up the claymore mine on it. He quickly covers it up and runs off again. The soldiers with the dogs are lead to the mine and bomb. When they inspect it closer, they cause it to activate and explode, which destroys a good chunk of the jungle. Rambo gets knocked off his feet by the blast.
School Boy and Sarah almost make it to the boat when they stop suddenly. Sarah asks him what’s wrong, and School Boy shows her with his sniper scope. Lewis and the others made it to the boat, but so have Aye and his men. The soldiers beat the hell out of the mercenaries and missionaries. Aye then personally walks to each one and viciously beats them with bamboo. Lewis calls him a pussy, and so Aye jams the bamboo stick into his leg wound. School Boy also sees somewhere behind him that there’s a jeep with a mounted machine gun in the back. The soldiers line up everyone and prepare to kill them. School Boy says that there’s nothing they can do. Slowly, Rambo appears behind the soldier using the mounted machine gun and decapitates him with his blade. He then grabs the gun and blasts the soldier in the front seat, splattering his body everywhere. Rambo then proceeds to open fire on the other soldiers, graphically blasting them in half and sending their body parts flying in the air. Lewis and the others fight back and kill off the soldiers around them. More soldiers come, but Rambo continues to mow them down into nothing. The guide comes back with rebel soldiers, and they partake in the huge battle. Aye calls in support from an army ship, which fires upon the rebel soldiers. During the carnage, Diaz is set on fire by a flamethrower and Aye kills a missionary before running off. Lewis kills a soldier that was about to throw a grenade. Unfortunately, this causes the grenade to fall near En-Joo, and the explosion kills him. Lewis is shot in the shoulder by a soldier, but Michael tackles the soldier and beats him to death with a rock. Rambo is shot through the shoulder by one of the guys on the ship and screams in pain. He sees another truck full of Burmese soldiers coming straight for him, and so Rambo annihilates the soldiers by firing at them with his huge machine gun. He then fires upon the ship, causing one guy's head to explode, and the guide blows it up with a grenade launcher.
Aye runs off by himself into the jungle, but is suddenly stabbed through the chest by Rambo with his blade. Rambo slices his stomach open and kicks his body down a hill, causing his intestines to fall out. Rambo stands on top of the hill, looking down upon the survivors of the battle. Sarah looks around for Michael, and is relieved to find him alive. Lewis is still alive, as is School Boy, but Reese’s corpse is seen nearby. Michael waves to Rambo as he stands by himself and nurses his shoulder wound. Next, we see Rambo walking down a highway, wearing his green army jacket and carrying a bundle over his shoulder. Rambo makes his way to a mailbox which has “R. Rambo” written on it. The film ends with Rambo, looking back at the road from which he came, and then finally walking back to his home.
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