Could be a) pain still felt - at times - after last year's spine treatment/surgery, no cortico or painkillers allowed/desiredI have no idea what to make of that.
b) good promotion of the aforementioned hospital
It could be, or not, related with today's performance. I'd say more as in hampering his prep than the actual race.
As for today, it was similar with the latest races, always in front, active (he followed with ease a few accelerations from Valverde and others on the first few San Luca climbs) then struggled on the penultimate but was in the favorites group just to switch off when the hammer went down on the last climb.
I'm still not totally depressed about Lombardia but with no team and his dubious shape it doesn't look too good.