Emergency services were called to an incident near Helensburgh on Sunday morning, after two cyclists were injured in a fall.
Ambulance NSW Chief Inspector Illawarra Terry Morrow said the couple were in a stable condition.
"It was a husband and wife riding their pushbikes, and apparently they've come together, one's hit the back wheel or something like that.... And they've both toppled over," he said.
"The husband was knocked unconscious, and also the wife."
During treatment by paramedics, Insp Morrow said the couple were in and out of decreased levels of consciousness, with symptoms typical of people in a concussed state.
Insp Morrow said the man had possibly suffered rib fractures and a possible fractured pelvis.
"The wife had a concussion as well, and abrasions on her body," he said.
Both patients were taken to St George Hospital, with the man airlifted and his wife transferred via road.
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