The card will comprise matches resulting from scripted storylines, with results predetermined by WWE on the Raw và SmackDown brands.[4][5][6] Storylines are produced on WWE's weekly television shows, Monday Night Raw and SmackDown Live.[7]

At Money in the Bank, Alexa Bliss won the women's Money in the Bank ladder match. Later in the night, she interrupted the Raw Women's Championship match between Ronda Rousey and champion Nia Jax, causing a disqualification, and cashed in her Money in the Bank contract to win the championship.[8] The following night on Raw, Jax invoked her championship rematch clause for Extreme Rules. Rousey was also suspended for 30 days as she attacked Raw General Manager Kurt Angle, who was trying to break up the fight between Rousey and Bliss.[9] On the July 2 episode of Raw, the match at Extreme Rules was made an Extreme Rules match, and Rousey stated her intentions to be in the front row for the match.[10]

At Money in the Bank, AJ Styles retained the WWE Championship by defeating Shinsuke Nakamura in a Last Man Standing match.[8] On the following episode of SmackDown, Rusev won a gauntlet match also involving The Miz, Daniel Bryan, Samoa Joe, and Big E to earn a title opportunity at Extreme Rules.[11]

Prior to the gauntlet match, Daniel Bryan had a stare down with SmackDown Tag Team Champions The Bludgeon Brothers (Harper và Rowan). During the gauntlet match, The Bludgeon Brothers attacked Bryan, allowing Miz to eliminate Bryan.[11] On the June 26 episode of SmackDown, Kane returned to save Bryan from a post-match assault from The Bludgeon Brothers, reuniting Team Hell No. SmackDown General Manager Paige then scheduled Team Hell No to face The Bludgeon Brothers for the tag titles at Extreme Rules.[12]

On the June 4 episode of Raw, The B-Team (Bo Dallas và Curtis Axel) won a tag team battle royal to earn the right to face Matt Hardy và Bray Wyatt for the Raw Tag Team Championship by last eliminating Heath Slater và Rhyno.[13] On the June 25 episode of Raw, Axel defeated Hardy and the tag team title match was scheduled for Extreme Rules.[14]

At Money in the Bank, Carmella retained the SmackDown Women's Championship by defeating Asuka with the help of the returning James Ellsworth.[8] On the following episode of SmackDown, Carmella attacked Asuka after a distraction by Ellsworth.[11] On the June 26 episode of SmackDown, General Manager Paige scheduled a rematch for the title at Extreme Rules.[12]

On the June 18 episode of Raw, Dolph Ziggler defeated Seth Rollins to win his sixth Intercontinental Championship after Drew McIntyre distracted Rollins.[9] The following week, Rollins won a rematch for the title by disqualification after McIntyre interfered on Ziggler's behalf.[14] On July 2, a 30-minute Iron Man match between the two was scheduled for Extreme Rules.[15]

On the June 18 edition of Raw, Raw General Manager Kurt Angle scheduled a multi-man match for Extreme Rules, with the winner facing Brock Lesnar for the Universal Championship. Roman Reigns, claiming to be the "uncrowned champion" due to the controversial finish of his championship match at Greatest Royal Rumble, and Bobby Lashley, claiming to be the only person who could legitimately match Lesnar, were the first two participants confirmed for the match.[9] The following week, however, the match was canceled over contract disputes with Lesnar. Reigns and Lashley wanted to face each other, but Angle instead had them team up against The Revival (Scott Dawson và Dash Wilder). Reigns and Lashley lost[14] and in a rematch the following week, Reigns refused to tag in Lashley and Lashley abandoned Reigns to a post-match beat down by The Revival. A match between Lashley and Reigns was scheduled for Extreme Rules.[10]