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The snow in game is much deeper than you may think or expect. And it may have lots of rocks, sticks and other debri hidden under it. It snows an awful lot, things get covered. So, you slide down a slop, or trip and fall with a 30 kg back[ack on your back, you are likely to get a few injuries and tear some clothing that may get snagged by said debris.
And if it really bothers you, you can use the Custom settings in Survival Mode, to toggle off Sprains and any other sundry afflictions listed there with binary on/off toggles. Don't like Cabin Fever? Trun it off. Don't like Sprains, turn them off. Hate Dysentery? Turn it off. You have 56 settings you can toggle on/off or adjust for rates and "likelyhood". Try a few out, in a new game, and see if you can find settings that customize the game to your preferences.
You may want to grind for Feat badges in stright Pilgrim beforehand thugh, since Feat badges do not progress with custom settings, But Steam/XBox/PlayStation achievements will still unlock. Just not the Feat perks.
Falling onto snow is even worse than trying to walk on it. Have you ever fallen onto moderately packed snow that has layers of ice in it from melt and freezing rain? I have, from a 5-10 foot fall (approx) onto snow described above, I snapped my arm clean in half from trying to break my fall. Both bones. Then had the arm of my coat torn from the ice shards where my arm impacted. Falling onto snow is not like jumping into a pile of leaves, which is how you describe snow as. Again, when it's first fallen yes, it's similar to that. Apply pressure to it from being walked on, a little heat and a bit of time and you may as well be falling onto concrete.
PS. I just sprained my ankle out of nowhere. No incline, no nothing. Just walking back to homebase and SNAP. Can't sprint. RNGesus hates me.
What im saying is this game will try to kill you every time it has a chance.
It is actually a bit surprising that tumbles down steep hills at those weights don't cause more atual broken bones injuries. Especially with the nutritional deficits most of our characters have from the limited soruces of foods. Not a tom of Calcium, Vitamin A & D in our diets in the game. Maybe lots of protein, but not enough fatty acids, Vitamin C, Zinc, and B vitamins either. Especially gor citified survivors like ours.
Just saying, it really isn't that unrealistic.