Objectives The primary objective was to study the adoption of the NHE programme in European football teams in the 2020/21 season and to compare it to the previous study. A second objective was to compare hamstring injury rates between teams that used the NHE programme in the team training and teams that used the NHE only for players with previous or current hamstring injuries. Methods Data about the implementation of the NHE programme and injury rates were included for 17 teams participating in the Elite Club Injury Study during the 2020/2021 season. Results One team (6%) used the full original NHE programme, and another four teams used it for all or most players in the team (team training group, n=5). Eleven teams used NHE only for players with a previous or current hamstring injury (individual training group), and one team did not use NHE. The team training group had fewer hamstring injuries (5 vs 11 per team, p=0.008) and a lower injury burden (12 vs 35 lay-off days per 1000 hours, p=0.003) than the individual training group. Conclusion Similar to previous reports, low adoption of the NHE programme was seen in the 2020/2021 season. The low adoption rate (13%) relates to the number of teams fully or partly using NHE programmes. Teams that used NHE for the whole team or most players had a lower hamstring injury burden than teams that used NHE only for individual players.