John Cena vs Big Show(Submission match)

Dark Mickie James and Kelly Kelly defeated Beth Phoenix and Rosa Mendes Tag Team match
1. Kofi Kingston © defeated Montel Vontavious Porter, William Regal and Matt Hardy Fatal Four-Way match for the WWE United States Championship
2. Chris Jericho defeated Rey Mysterio © No Holds Barred match for the WWE Intercontinental Championship
3. CM Punk defeated Umaga Samoan Strap match
4. Tommy Dreamer defeated Christian © and Jack Swagger Triple Threat Hardcore match for the ECW Championship
5. Santina Marella defeated Vickie Guerrero © (with Chavo Guerrero) Hog Pen match for the title of "Miss WrestleMania"
6. Batista defeated Randy Orton © Steel Cage match for the WWE Championship
7. John Cena defeated The Big Show Submission match
8. Jeff Hardy defeated Edge © Ladder match for the World Heavyweight Championship
9. CM Punk defeated Jeff Hardy © Singles match for the World Heavyweight Championship (CM Punk cashed in his Mony in Bank briefcase)

Extreme Rules will feature professional wrestling matches that will all be contested under some of the most extreme stipulations. It will involve different wrestlers from pre-existing scripted feuds, plots, and storylines that will be played out on Raw, Friday Night SmackDown, ECW on Sci Fi and WWE Superstars—World Wrestling Entertainment's (WWE) television programs. Wrestlers will portray a villain or a hero as they follow a series of events that build tension, and culminate into a wrestling match or series of matches. All wrestlers will be from WWE's Raw, SmackDown, and ECW brands—a storyline division in which WWE employees are assigned to a television program of the same name.

The primary rivalry heading into Extreme Rules from the Raw brand is between Randy Orton and Batista, who are feuding over the WWE Championship. At WWE's previous pay-per-view event, Judgment Day, Orton lost his match against Batista by getting himself intentionally disqualified for hitting the referee, but retained the WWE Championship. As a result, on the May 18 episode of Raw, Ric Flair, an associate of Batista, announced that the Raw general manager, Vickie Guerrero, had decided that Orton would face Batista in a steel cage match at Extreme Rules, once again defending his WWE Championship.

Another rivalry from the Raw brand is between John Cena and The Big Show (Paul Wight). At WWE's April pay-per-view, Backlash, Big Show interfered in Cena's Last Man Standing match against Edge and chokeslammed him though a spotlight, causing Cena to lose the match and the World Heavyweight Championship to Edge; Cena exacted revenge at Judgment Day. Then, on the May 18 episode of Raw, it was announced Big Show would have a rematch with Cena at Extreme Rules in a submission match, which can only be won by a wrestler forcing their opponent to submit.

The main rivalry heading into Extreme Rules from the SmackDown brand is between Edge and Jeff Hardy, over the World Heavyweight Championship. After Edge retained the championship against Jeff Hardy at Judgment Day, Theodore Long, the SmackDown general manager, announced on the May 22 episode of SmackDown that, due to Matt Hardy's interference in the title match at Judgment Day, Jeff Hardy would get a rematch against Edge. Long stated that the match would be contested under Extreme Rules, with the stipulation being chosen by winner of the match between the two later in the night. Hardy won the match, and chose a ladder match, which requires the competitors in the match to climb a ladder to obtain the title belt suspended over the ring in order to win.

After defeating CM Punk at Judgment Day, Umaga continued to attack Punk, and interfered in Punk's match with Chris Jericho on the May 22 episode of SmackDown, assaulting Punk with a leather strap, and issuing a challenge to Punk for what he called a Samoan strap match at Extreme Rules.

The primary rivalry from the ECW brand is between Christian (Jason Reso), Jack Swagger (Jake Hager) and Tommy Dreamer, who are feuding over Christian's ECW Championship. After Christian retained the ECW Championship against the former champion, Jack Swagger at Judgment Day, Swagger attacked Christian on the following episode of ECW and pushed him off the entrance ramp. Two days later, on Superstars, Swagger interfered in a title match between Christian and Dreamer, resulting in the match being ruled a no contest. On the May 26 episode of ECW, Swagger announced that Christian would be defending the championship against him again at Extreme Rules, but the ECW general manager, Tiffany (Taryn Terrell), stated that Dreamer had been added to the match, making it a triple threat hardcore match, a match with no disqualifications or countouts, and the first man to score a pinfall or submission would win. As Dreamer's contract with the company expires one day before the show, it was announced that he had signed a one-day extension to give him a chance at winning the title; if Dreamer were to fail to win the title, he would no longer wrestle for ECW. Just like Backlash 2009, every world title changed hands. The ECW champion Christian, who won the gold at Backlash 2009, was defeated by Tommy Dreamer. The WWE Champion Randy Orton, who defeated Triple H at Backlash, was defeated by Batista. And lastly, Edge who won the Worlds title at Backlash, was defeated by longtime rival Jeff Hardy in a ladder match. Straight after this contest, CM Punk cashed in his money in the bank contract to win his second World title.