We review the current status of knowledge regarding the role that flow parameters play in controlling the macrophyte communities of temperate lowland rivers. We consider both direct and indirect effects and the interaction with other factors known to control macrophyte communities. Knowledge gaps are identified and implications for the management of river systems considered. The main factors and processes controlling the status of macrophytes in lowland rivers are velocity (hence also discharge), light, substrate, competition, nutrient status and river management practices. We suggest that whilst the characteristics of any particular macrophyte community reflect the integral effects of a combination of the factors, fundamental importance can be attributed to the role of discharge and velocity in controlling instream macrophyte colonisation, establishment and persistence. Velocity and discharge also appear to control the relative influence of some of the other controlling factors. Despite the apparent importance of velocity in determining the status of macrophyte communities in lowland rivers, relatively little is understood about the nature of the processes controlling this relationship. Quantitative knowledge is particularly lacking. Consequently, the ability to predict macrophyte abundance and distribution in rivers is still limited. This is further complicated by the likely existence of feedback effects between the growth of macrophytes and velocity. Demand for water resources increases the pressure on lowland aquatic ecosystems. Despite growing recognition of the need to allocate water for the needs of instream biota, the inability to assess the flow requirements of macrophyte communities limits the scope to achieve this. This increases the likelihood of overexploitation of the water resource as other users, whose demands are quantifiable, are prioritised.