Yo! Steam has an 'Alternate Launch' option that may help? Would you be able to see if the game launches with that?
Additionally, if you can go to your C:\Users\%UserProfile%\Zomboid folder and find the options.ini file: Inside there may be a fullscreen=true line. If there is, try changing it to fullscreen=false
If still no luck, post a link to your latest console logs (you can use a temp filesharing website for files if you'd like) and I can see if there's any clues pointing to the source of the problem?
What was the source/cause of the muscle strain?
It's possible (and I'm only guessing here) that the option to turn it off relates to combat-induced strain, rather than climbing, exercise, woodcutting, etc.
Could that be relevant?
Tried on our branch, and switched to the current unstable with maximum sandbox for vehicles and road stories and fast move in Muldraugh (and Louisville to strain it as much as possible) and had no issues to be able to reproduce it unfortunately.
Maybe try reinstalling the game freshly on Steam if you haven't double checking mods are fully disabled, and/or verifying integrity of the game's files. It could be an issue on our side for sure, but one different circumstance we may not have accounted for might be not allowing me to reproduce it, or it may just be unclean files on your PC somehow triggering an issue from leftover mods.