All they that see me laugh me to scorn: they shoot out the lip, they shake the head, saying,
They shoot out the lip - literally, 'they shoot out with their lips' х paaTar (H6362), to open, whence the Septuagint and the Vulgate take it, 'they spake with their lips']. They open their lips wide, to pour forth all insults (Isaiah 57:4).
They shake the head - a gesture implying that there is no hope for the sufferer, at whom they contemptuously sneer (Job 16:4; Psalms 44:14).