There is widely documented evidence that rivers are one of the most degraded ecosystem types on the planet. As a consequence, concerted efforts have been made to improve the health of river systems in many parts of the world. Moves towards sustainable management approaches reflect transitions beyond the imposition of ‘command-and-control’ approaches towards ecosystem-framed applications. Although this transition is now well-understood in intellectual terms, there is little evidence of a genuine shift in practice and associated outcomes. Governance frameworks underpinning management practices have been identified as a key limitation in catalysing this transition. This paper provides an overview of governance frameworks and practices which underpin river management goals. Middle-ground governance frameworks that facilitate the interaction of top-down and bottom-up approaches are promoted as this structure allows for values and processes operating across multiple spatial and temporal scales to be included in management. Case studies from New Zealand, Canada and England are used to demonstrate the diversity of governance spaces that middle-ground initiatives can occupy, reflecting the unique socio-ecological and institutional trajectory of any given catchment. Middle-ground organisations at the catchment scale provide a focal meeting point to pool resources and set goals for decentralised, reflexive structures. This transition in practice is critical if contemporary top-down approaches are to be modified to foster adaptive ecosystem-based applications that incorporate participatory decision-making at a catchment scale. These considerations are vital if appropriate platforms are to be established to maximise efforts for sustainable river management.