Murder victim Meredith Kercher was kneeling on the ground with her face pushed virtually to the floor when she was fatally stabbed from behind, a court heard.
Kercher, 21, was found semi-naked and with knife wounds to the throat in the bedroom of the student house she lived in.
Prosecutors claim she died after refusing to take part in a drug fuelled sex orgy.
Her roommate Amanda Knox, 21, and Knox's former boyfriend Raffaele Sollecito, 25, are jointly on trial for murder and sexual assault.
In the latest court hearing, blood pattern analyst Francesco Camana used a series of photographs to illustrate how he believed Meredith had died.
The graphic photographs showed blood stains on the floor and wardrobe in Meredith's bedroom where she was found dead in November 2007.
''From the photographs of the blood pattern we can see that when Meredith was fatally knifed in the throat she was no more than 40cm from the floor," Camana told the court in Perugia.
''She was kneeling down in front of the wardrobe, her face was pressed almost to the floor, she was on her knees with her chest pushed forward and her legs behind her.''
During the hearing Knox and Sollecito listened intently, often making notes and discussing evidence with their legal teams as the prosecution case reaches its final stages.
Knox is expected to give evidence sometime in June, along with Meredith's mother Arline and her sister Stephanie.
Meredith, from Coulsdon, Surrey, was in Italy on a year-long exchange programme as part of her European Studies degree at Leeds University.
She had only been in Perugia for two months when she was killed.