Yes, strangulation first rules out accident.
Head blow second rules in ritual.
Blazeboy3, I mean JonBenet's death does not revolve around sexual abuse as so many of the lay detectives think.
Patsy did the deed but she was using JonBenet before the famous deed in ways that had nothing to do with sex and she continues to use her in ways that have nothing to do with sex.
The Psalms are refered to over and over by Patsy before the event, after in DOI and in the ransom note. Patsy repeatedly ties the angel theme to JonBenet, again before, after and during the event. Patsy's ruminations on God are projected on to JonBenet.
The blow to the head, the initial strangulation, the final position of the garrote, the raising of the arms, the implied posing of the body and the duct tape point to obsessional thinking about corporeal issues in the upper region. And the large panties refer to lower body issues.
The nature of this crime points to a wide spectrum of psychological and physical concerns in the perp, not just sex.