MADRID — Rafael Nadal finally won another clay-court title, although not in a manner that alleviated any concerns about his recent form on his favorite surface. The top-ranked Spaniard won his fourth Madrid Open Sunday after Kei Nishikori was forced to withdraw with a hip injury when trailing 2-6, 6-4, 3-0 in the final. And Nadal, who is coming off to uncharacteristic quarterfinal losses on clay, said his mental strength is still lacking just two weeks ahead of the French Open. “I was blocked. There were some moments where, I don't know, I couldn't find myself,” said Nadal, whose victory guarantees he will stay No. 1 in the rankings heading into Roland Garros. “It wasn't that I didn't want to play or I was missing intensity, I was just mentally blocked.” Nadal became the first repeat winner in Madrid but it was only his second clay-court title of the year, and third overall in 2014. Nishikori's aggressive start allowed him to jump out to a 5-1 lead as his powerful groundstrokes overwhelmed Nadal, who struggled to find an answer against his Japanese opponent. Nishikori broke Nadal again to start the second set to leave the Magic Box center crowd, which included Queen Sofia, dumbfounded to find Nadal struggling so badly. Nishikori first experienced discomfort while leading 4-2 and Nadal took advantage to break back. Nishikori soon needed a medical timeout for treatment on his back and hip, and his energy then looked sapped as he hit a shot long to concede the set. Nishikori, who withdrew from next week's tournament in Rome to recover in time for the French Open, visibly struggled in the third before eventually retiring. “It was very sad, especially (since) I was winning, playing almost best tennis in my life,” said Nishikori, who will become the first Japanese player in the top-10 when the new rankings are released. “It was very tough mentally for me. But I get a lot of confidence from this tournament.” Nadal believes Nishikori's storming progress could be halted by the Japanese star's frail physique. “Kei promised a lot of things, promised a lot a couple years ago, and he's still very young. He has had a couple of injuries. Whenever you suffer injuries everything is really complicated,” said Nadal. “I'm sure that he's going to be within the best. I'm sure if he keeps playing that level he's going to be a clear candidate to be up there. “But to be No. 1 he has to show if he's capable of playing with high regularity all year and being able to win on all surfaces.” In 2012, he had to skip the French Open with a stomach injury. Now he withdrew as expected from the Rome Masters. Dimitrov advances in Rome Grigor Dimitrov overcame a slow start and sweaty hands to beat 45th-ranked Edouard Roger-Vasselin of France 4-6, 6-3, 6-4 in the first round of the Italian Open Monday. The 14th-ranked Dimitrov, a Bulgarian who at 22 is the youngest player in the top 20, did not take well to the red-and-white towels at the Foro Italico. “They're new and they don't absorb any sweat,” he said. “Three or four times I was about to lose my racket. I asked several times (for all-white towels) but they told me, ‘We don't have it.'“ Dimitrov will next face big-serving Ivo Karlovic, who beat Spanish qualifier Pablo Carreno Busta 3-6, 6-3, 7-6 (4). In an upset, 13th-seeded Fabio Fognini, the top Italian hope, was handily beaten by 56th-ranked Lukas Rosol of the Czech Republic 6-3, 6-2. In women's play, 11th-seeded Ana Ivanovic defeated Italian wild-card entry Karin Knapp 6-1, 6-1, 1999 champion Venus Williams cruised past Annika Beck of Germany 6-3, 6-1, local favorite Francesca Schiavone of Italy eliminated 17th-seeded Eugenie Bouchard 6-4, 6-2, and Svetlana Kuznetsova ousted fellow Russian Maria Kirilenko 7-5, 6-0. The eight top-seeded players have first-round byes. Second-ranked Novak Djokovic is back after withdrawing from last week's Madrid Open with a right wrist injury and Roger Federer was out on the practice courts after also taking last week off to welcome the birth of his second set of twins. — Agencies