The Matakitaki River originates on the north-western slopes of the Spenser Mountains and flows north approximately 74 kilometres to join the Buller River near Murchison. The river drops at an average gradient of 4.8 metres per kilometre overall, though specific sections are considerably steeper. It is a year-round paddling destination that rarely drops too low during summer months.

The river offers several distinct sections suited to different skill levels. The middle Matakitaki runs at Grade 2+ and is considered a scenic run with good eddy lines for skill development, including opportunities to practise swimming and throw-bag work. The Mammoth Gorge section runs at Grade II to II+, while Horse Terrace Gorge steps up to Grade III+. The lower section, sometimes called the Earthquake section after the rapid formed by an old slip from the Murchison earthquake, is a short but demanding run of roughly 1.25 miles at Class III+ to IV, with a gradient averaging 56 feet per mile. This lower section can be accessed via Matakitaki West Bank Road off Highway 6 west of Murchison, with both put-in and take-out on the same road, making the shuttle approximately 1.25 miles and around five minutes by vehicle. The lower section is noted as potentially very hazardous at certain flows and requires careful judgment.

The river transitions through several distinct characters along its length. Upper reaches are a small, braided shingle river with a narrow bed above Horse Terrace Bridge. Below the bridge the river runs over a stony gravel bottom in a single channel with small rapids, before entering a short gorge below Ten Mile Creek where larger rapids appear. Further downstream the river opens into low islands, gravel chutes, and willows before reaching Earthquake Rapid. Farmland, scrub-covered hills, blackberry, and fern flank much of the corridor.

The Murchison area is regarded as a strong destination for beginner and intermediate whitewater paddlers, with the middle section in particular considered worth running more than once. The lower section's short shuttle allows for laps, and a complete run from Murchison can be completed in as little as an hour. Flows are described as ranging from around 750 cfs upward, with the character shifting from boofs and defined eddies at lower water to pushy, punchy rapids at higher flows.