A prayer born from a double crisis of sickness and persecution opens this song. It flows naturally from the ideas explored in the prayers that came before it [רד״ק]. The primary approach among commentators is that David composed this work while suffering from a severe physical illness. His goal was to confess his sins from his sickbed, asking God to raise him up and heal him [מאירי, מלבי״ם].
Alongside his failing health, David faced an active threat from his enemies. They rejoiced at his terrible condition and eagerly hoped for his death [מאירי]. Some even tried to take advantage of his vulnerable state by attempting to poison him with a deadly drug [מלבי״ם]. Feeling completely helpless against both the disease and his enemies, David asks God for salvation. He describes the constant divine protection that covers and guards the weak and poor [מלבי״ם].