David Howell is still carrying his shoulder problem but it was Ryder Cup partner Paul Casey who was the main focus of attention when the Volvo Masters resumed at Valderrama today.

Casey, leader of the European Tour Order of Merit with just three rounds left, felt "the worst I've ever felt on a golf course" when labouring to an opening 76 yesterday.

Close to being sick because of stomach cramps, the 29-year-old was relieved to complete the 18 holes "without making a mess".

Clutching his bag for support, the World Match Play champion forgot about his bid for the money list title for a while and called for medical help on the course.

Casey said: "Although it was not too bad starting out, I was not feeling good. But then it just got worse and worse.

"My stomach really cramped up on the 10th tee and on the 11th I got an injection to stop the nausea and a pill to solidify the rest.

"It feels like 'flu because my whole body is aching. In any other circumstances I don't think I would have kept playing, but I'm not a fan of pulling out and I think I should keep going as long as I can or a doctor says otherwise.

"I had Parma ham and melon and some pasta last night, but I don't know whether it was that. Two caddies were feeling bad this morning as well - and one of them was on a drip.

"I wasn't even thinking about the score. I'm a long way back, but I'll just try to get under par by the end of the week."

His round left him joint 43rd of the 54 players and 10 adrift of Spanish leader Jose Manuel Lara, but still in position to retain top spot.

Padraig Harrington, Howell and Robert Karlsson are the only three players who can deny him the money list crown.

Dubliner Harrington requires a top-three finish, but was only 30th overnight following a 73, while the other two have to be first or second and Howell's 70 put him 14th and Karlsson's 69 left him tied for seventh.