Production notes

The film was an independent production between Nu Image and Emmett/Furla Films for Equity Pictures Medienfonds GmbH. It was green-lit and sold before Rocky Balboa was released. In between the making of Rambo III, the previous installment in the Rambo franchise, and this film, the films' original producer, Carolco Pictures, went out of business. In 1997, Miramax purchased the Rambo franchise. The following year, Miramax subsidiary Dimension Films intended to make another film, and a writer was hired to write the script, but attempts to make it were deterred by Sylvester Stallone, who had stated that he no longer wanted to make action movies. In 2005, the studio sold those rights to Millennium Films and Nu Image. Stallone had stated that part of the reason that it took so long to produce a fourth film was due to a lack of a compelling story that motivated him to return to the role. An early idea was to have John Rambo travel to Mexico to rescue a kidnapped young girl. Stallone thought it was "good", however, he felt the idea lacked the "essence of Rambo", still wanting the character to be a "lost man wandering the world". The premise would later be used for Rambo: Last Blood (2019). Charles Logan's novel Homefront was considered to be adapted as the fourth Rambo film, and was developed as much in the mid-2000's. The idea would have had Rambo return to the U.S. working as a DEA agent, having a daughter, and dealing with local meth dealers after moving to a small town in Louisiana. Stallone abandoned the Homefront draft because he felt it seemed premature to have Rambo return to America. Stallone would later revise the script as the 2013 film Homefront, which cast Jason Statham in the role of the DEA agent/father instead. Stallone got the idea to set the film in Burma from the United Nations, which he later pitched to producers. The producers found the idea compelling after visiting Karen refugee camps. Maung Maung Khin, a former Karen freedom fighter, stated that if he accepted the role of the film's villain Major Pa Tee Tint, there was a chance some of his family would have been incarcerated in Burma, but accepted the role regardless, feeling that bringing awareness of the Saffron Revolution was important.

A different director was originally attached to direct the film but left due to creative disagreements. Stallone was reluctant to direct the film due to not being prepared nor having a vision for the film but later became excited when he came up with the idea of "what if the film was directed by Rambo? What if the film had his personality?" Graham McTavish later echoed this idea, stating, "In many ways, Rambo directed the movie." Paul Schulze stated that there were rewrites by Stallone nearly every morning. The film had a production crew of 560 people, including 450 Thai crew members, and over 80 foreign members from Australia, America, Canada, Myanmar and the United Kingdom.

Stallone stated that due to the small production budget the only way to make the film memorable was to make it graphically violent. He said "we were all sitting around in looking at the small production budget. Then I said 'Hey, fake blood is cheap, let's make it all-out bloody.'" Filming started on January 22, 2007, and ended on May 4, 2007. It was shot in Chiang Mai, Thailand as well as in Mexico and the United States in Arizona and California. While filming near Myanmar, Stallone and the rest of the crew narrowly avoided being shot by the Myanmar military. Stallone described Burma as a "hellhole". He said, "We had shots fired above our heads" and that he "witnessed survivors with legs cut off and all kinds of land-mine injuries, maggot-infested wounds and ears cut off."

John Rambo was the original working title for the film but was changed in the US because Stallone thought that audiences might think that this is the final film in the Rambo series, due to the then recently released Rocky Balboa (2006), which was not his original intent. In many other countries, the title John Rambo is used because the first Rambo film First Blood was known as Rambo in those countries. The film premiered on US television as Rambo, but the title sequence referred to it as John Rambo. On October 12, 2007, Lionsgate Films announced that the film title was being changed to Rambo: To Hell and Back. After some negative feedback from the online community, Stallone spoke with Harry Knowles and said:

Lionsgate jumped the gun on this. I just was thinking that the title John Rambo was derivative of Rocky Balboa and might give people the idea that this is the last Rambo film, and I don't necessarily feel that it will be. He's definitely a superb athlete, there's no reason he can't continue onto another adventure. Like John Wayne with The Searchers.

Rambo (2008) was a box-office success. It opened in 2,751 North American theaters on January 25, 2008, and grossed $6,490,000 on its opening day, and $18,200,000 over its opening weekend. It was the second highest-grossing movie for the weekend in the U.S. and Canada behind Meet the Spartans. The film has a box office gross of $113,344,290, of which $42,754,105 was from Canada and the United States. Europe's biggest cinema chain (and the third biggest in the world), Odeon, refused to show the film on any of its screens in the United Kingdom, due to a dispute with its British distributor Sony Pictures over rental terms for the film. The film was shown in Ireland and the United Kingdom by other theater chains such as Empire Cinemas, Vue, Cineworld and Ward Anderson. The film was not shown in the French-speaking part of Switzerland due to legal and commercial problems with the distributor, even if it was available on screens of France and the Swiss German-speaking part.

Rambo received mixed reviews, with critics praising the film's action sequences and Stallone's performance, but criticizing the film's excessive violence, with it being labelled a "blood bath", "orgy of violence", "splatter film", and "violence porn." On Rotten Tomatoes, the film has an approval rating of 38% based on 150 reviews, with an average rating of 5.2/10. The site's critical consensus reads: "Sylvester Stallone knows how to stage action sequences, but the movie's uneven pacing and excessive violence (even for the franchise) is more nauseating than entertaining." On Metacritic, the film has a weighted average score of 46 out of 100, based on 26 critics, indicating "mixed or average reviews". Audiences polled by CinemaScore gave the film an average grade of "A−" on an A+ to F scale. In his review for The New York Times, A.O. Scott wrote, "Mr. Stallone is smart enough—or maybe dumb enough, though I tend to think not—to present the mythic dimensions of the character without apology or irony. His face looks like a misshapen chunk of granite, and his acting is only slightly more expressive, but the man gets the job done. Welcome back." Michael H. Price of Fort Worth Business Press wrote, "Stallone invests the role with a realistic acceptance of the aging process, and with traces reminiscent of Humphrey Bogart in 1951's The African Queen and Clint Eastwood in 1992's Unforgiven—to say nothing of the influences that the original First Blood had absorbed from Marlon Brando in 1953's The Wild One and Tom Laughlin in 1971's Billy Jack."

When asked what his take on the film was, First Blood author David Morrell said:I'm happy to report that overall I'm pleased. The level of violence might not be for everyone, but it has a serious intent. This is the first time that the tone of my novel First Blood has been used in any of the movies. It's spot-on in terms of how I imagined the character—angry, burned-out, and filled with self-disgust because Rambo hates what he is and yet knows it's the only thing he does well. ... I think some elements could have been done better, [but] I think this film deserves a solid three stars. In 2022, Stallone singled out the movie as one of his best films:

One film I'm truly proud of—it's the best action film I've ever done because it's the most truthful—is Rambo IV, dealing with Burma, where they've had a civil war for 67 years. But I got excoriated because the movie's so violent. And it is violent. It's horrifying. It's children being burnt alive. That's what makes civil war worse than anything: It's your neighbor, all of a sudden, killing you. I was really happy with that film, and I never thought it would ever reach the theater. I thought, "They're never going to show this."

The film is banned by the Burmese government. Upon release, the then-ruling military junta ordered DVD vendors in Burma not to distribute the film due to the movie's content. Despite having never been released there theatrically or on DVD, bootleg versions of Rambo are available. The opposition youth group Generation Wave copied and distributed the film as anti-Tatmadaw propaganda. The Karen National Liberation Army has said that the movie gave them a great boost of morale. Some rebels in Burma have even adopted dialogue from the movie (most notably "Live for nothing, or die for something") as rallying points and battle cries. "That, to me," said Stallone, "is one of the proudest moments I've ever had in film." Also, overseas Burmese have praised the movie for its vivid portrayal of the military's oppression of the Karen people.