The petechiae and congestion (Page 5 of the autopsy “external description” ) noted on the eyes, eye lids, face, lips, mucosa of the mouth and gums, as well as the engorgement of the head and face structures, indicate that her heart was beating for a few minutes as she died from strangulation, and then a sudden slowing and stopping of the heartbeat from stimulation of both carotid sinuses from the ligature, as well as ongoing anoxia (“no oxygen” ). It is my understanding that manual (using hands) strangulation will produce hyoid bone fractures, and some petechiae in the eyes or lids, but rarely will cause the entire face and head to have petechiae. It would be hard for even a strong person to continue the pressure with their hands that long, past 10 minutes. (Try just clenching your fist for that long– your arms will fatigue after a few minutes.) And fracturing the thyroid cartilage takes some serious force.
Page 14 states there is no cerebral (brain) swelling. This is important, because to have brain swelling from a lack of oxygen, you have to survive the lack of oxygen occurrence long enough for the swelling to occur. The absence of cerebral edema says she was not anoxic (without oxygen) very long before her heart stopped beating, and she died.
Her injuries are very consistent with a drop of that length, as opposed to being staged into a noose from the ground below.