Adaptive management (AM) is an approach that uses targeted monitoring and investigation to improve future management practices in a structured and iterative way through reassessment of the efficacy of management policies and system understanding. AM has received significant attention in groundwater management for its purported capability to counteract key uncertainties inherent in estimating future environmental responses to human activities. While the theoretical strengths of AM have long been recognized, practical applications have produced mixed results across the many facets of environmental management. In this study, we review AM principles and groundwater management case studies, including urban water supply, agriculture and mining applications, to critically evaluate AM strategies applied to groundwater contexts. We identified substantial variability in the interpretation of AM principles across eleven groundwater case studies. Comparison of published AM guidelines and groundwater examples of AM plans revealed significant shortcomings in many AM applications, while a small number of AM plans largely adhere to the key components of AM identified in the guidelines. The most notable issues in the application of AM to groundwater activities include a lack of substantive mitigation measures and/or assessment of the potential for remediation. Construction of clear definitions and guidelines for AM applied to groundwater management is required to set the expectations of regulatory bodies and government departments responsible for assessing groundwater-affecting projects, and to ensure that the protective attributes of AM are properly incorporated into project plans. This will lead to greater transparency in groundwater related planning and expected outcomes for stakeholders.